In this episode, Rob interviews Liz Lees, Registered Dietitian, on how to recognize signs of an eating disorder, how to seek treatment, and how parents can support their child while in eating disorder treatment. Rob and Liz discuss how eating disorders impact physical and mental health, as well as the important role parents play through encouraging treatment, meal planning, and modeling healthy relationships with food and body image.

Eating Disorder Treatment at Doorways:

Doorways Phoenix

4747 N. Seventh St.

Suite 450

Phoenix, AZ 85014

602-997-2880

https://bit.ly/doorways-outpatient

Resources for Parents:

Blogs:

• Ask a Therapist: How Do You Identify Eating Disorders in Adolescence?
• Eating Disorders in Teens
• Talking to Teens About Nutrition as Self-Care
• How Nutrition Affects Teen Mental Health

Books:

• Sick Enough: A Guide to the Medical Complications of Eating Disorders
• How to Nourish Your Child Through an Eating Disorder: A Simple, Plate-by-Plate Approach to Rebuilding a Healthy Relationship with Food
• Life Without Ed

Videos:

• Eating Disorders: Tips for Supporting Teens and Young Adults
• How to Eat for Mental Health
• Taming the Shame Within

Liz Lees is Registered Dietitian at Doorways with a masters of science in clinical nutrition from Rush University. Liz has over 10 years of experience in both inpatient and outpatient clinical settings offering evidenced based nutrition counseling. She has specialized in treating client’s with digestive related conditions and eating disorder and is passionate in listening to and supporting her client’s unique needs towards recovery and overall wellbeing. Liz and her family love to spend time outdoors connecting with nature and camping in their RV.

Contact Liz: liz@doorwaysarizona.com

Rob Gent, M.A. LPC, is the Chief Clinical Officer and one of the founding members of Embark Behavioral Health. Rob has been with the company for 15 years and has led the Embark organization in clinical development and growth of numerous programs. He is the lead developer of the proprietary CASA Developmental Framework, which is pervasive throughout Embark’s programs.

Through his dedication to advancing clinical development, practice, and research, he has become a nationally recognized expert in the field. His specialization in clinical development is enhanced by his therapeutic expertise and has yielded such accomplishments as the development of; The CASA Developmental Framework, Vive Family Intensive Program, Calo Preteens, Canine Attachment Therapy-Transferable Attachment Program, and other specialized programs.

Rob’s dedication has led him to pursue his Ph.D in Psychology with an emphasis on development and attachment. He remains passionate about neurological, psychological, and physiological development and continues to focus on advancing research and the effectiveness of therapeutic interventions.

He resides in Tempe, Arizona, with his wife and two boys.

Connect with Embark on Social Media:

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Have a question for our experts? We want to hear from you! Submit your questions to: askatherapist@embarkbh.com

Well welcome everybody to Roadmap to Joy. Super, super

privileged today to have our guest with us Liz Lees. She's a

registered dietitian with an expertise in eating disorders.

We're going to be talking about eating disorders today. Such a

prevalent thing in our society.

It is.

Holy cow.

It absolutely is.

Yeah. So obviously, you've you've seen a need, and

we're addressing that and your workplace is Doorways, maybe

just talk a little bit about where you work would be

fantastic.

Yeah, absolutely. Yeah. So doorways Counseling

Center is a outpatient mental health clinic specializing in

adolescent care. So specifically there, the majority of my

clients I work with are going to be in the teenage age range with

suffering from various types of eating disorders.

Okay, great. Great. And that's here in Arizona.

Yep. Located right in central Phoenix.

Oh, fantastic.

Well, we're so privileged to have Liz on eating disorders. We

wanted to be able to address this because just want to talk

about a little bit of the statistics. In preparing for our

time together. This was just fascinating to me, that we're

going to talk about ED today. We don't want to mistake that with

anything else. But it's really eating disorder. When we talk

about that,

Yes. Not emergency department, not anything else.

In the context of today.

Yeah, great to be using this term, ED, but it's

really stands for eating disorder. And some of the facts

just the statistics are pretty staggering. But eating disorder

affects nearly 10% of the population worldwide. So is that

surprising to you, Liz?

No, it's not. I mean, it's it's an alarming statistic.

And it's alarming because it's so misunderstood. Still, there's

such a lack of knowledge out there in our general population

within health care providers even and so for such a high

number, you would think there would be a lot more

understanding of it.

Well, and I'm excited to talk today because I think

like you're saying, there's just not a lot of knowledge around

it. Many people who hear of eating disorder might think of

anorexia or just bulimia, but every day, a little bit of a

different twist on things, different strains, we're seeing

different variations of that or labeling thing. So I'm ecstatic

to have you today to kind of clear up some of this stuff for

us. Yeah, yeah. So we have 10% of the population worldwide is

affected by an eating disorder, nearly 30 million Americans will

have an eating disorder in their lifetime.

Wow. It's a big number.

30 million.

Wow.

Oh, my gosh, this was really quite staggering to me.

10,200 deaths occur each year as the direct result of an eating

disorder.

Yeah, it for a while was number one, I believe it's

moved on to the number two highest cause of mortality

within mental health conditions.

That is, they broke it down, one every 52 minutes.

Wow. I haven't heard that statistic. And that that's,

wow,

One person every hour, basically, as the direct result

of an eating disorder. So I'm glad we're all tuning in today.

Because this this affects us. The economic cost of eating

disorders is nearly $65 billion a year

Sheesh, it's a big number.

It's a big number. So I'm really glad that we're

talking about some of this stuff. So we're going to be

talking about treatment. We're gonna talk about things, which

is to gain some knowledge, what can we identify, especially for

parents, and we have these adolescents, young adults, what

can we look for? It's important to talk about treatment. So a

few stats, over 50% of individuals with eating

disorders meet criteria for depression and anxiety.

Yes, I mean, it's eating disorders themselves are

a psychological condition, there tends to be so much overlap with

CO comorbidities of depression, anxiety, other mood disorders.

So absolutely, it plays a huge role in eating disorders, and

how they're treated.

And I would love to talk a little bit about shame,

right? Shame associated with all this. I can't imagine that's a

huge part of the whole treatment process.

Oh, absolutely. I mean, there's still so much

taboo with with, especially within certain maybe cultures or

family dynamics about even talking about. E specially maybe

even looking in male populations.

Yes,

So underserved as far as getting treatment and a lot

And I think many of us think of this as primarily, a feminine

of that comes down to that word shame.

issue.

Yeah, I hear that all the time. Still today that, oh, this only

affects girls, and it's absolutely just not true.

It's not true.

It's not true at all. We're seeing such a growing

emergence in subpopulations. I mean, eating disorders do not

discriminate by socioeconomic status, race, gender, sexual

orientation. In fact, we're seeing growing number of these

subpopulations being diagnosed. And it's not that there's

necessarily this bigger emergence of it happening, but

rather, maybe we're starting to catch and recognize it a little

bit more than we used to.

Let's talk a little bit about treatment. Some stats

are only one in 10, individuals with an eating disorder actually

received treatment.

Wow, that's low. It's unfortunate.

Yeah, 1/10 1/10, this entire population is actually

receiving treatment, only 35% of those who receive treatment for

ED, are treated by a specialized program or professional in this

field.

Gosh, yeah. And, you know, I think a big part of that

comes down to, again, kind of talking how eating disorder

aren't discriminating by my economic privileges or

disadvantages. And treatment can get very costly. And so I think

a lot of that can play a role in to just the affordability for a

lot of families to undergo treatments and get that

specialized care team.

What we're going to talk about a little bit later,

because I would like to build on this specialization, kind of,

you know, if you had a transmission issue on your car,

you might take it to a mechanic, but you're wanting somebody to

focus on that specifically, right? To make sure they have

expertise, or I have a heart condition. I'm gonna go to the

Mayo Clinic, maybe just touch a little bit about why is this

specialization important? Especially if I'm a generalized

therapist, I can I send my child who might have an eating

disorder to a general therapist, and they're going to talk about

anxiety depression, is it is a specialization important is

talking about that specific issue is addressing that issue

important from your standpoint?

Yeah. So I mean, my analogy that I love to provide

as if we look at doctors with different specialties, if my kid

got diagnosed with cancer, awful, would I take them to a

general pediatrician? Or would I go and find a pediatric

oncologist to help treat that specific condition? It's the

same thing with eating disorders, you need a team that

truly understands the complexities that are an eating

disorder to be able to address it and potentially, you know,

not do more harm, as I can see that, in some instances. If we

don't know is up to health care providers, what to even look for

and eating disorders, or the do's and don'ts of communication

are huge. We can potentially do more harm if we just don't fully

understand the condition. So absolutely. A specialized care

team is important.

Similar to Doorways, yeah,

Absolutely.

Yeah. Terrific. Well, Liz, thank you for that. If

let's go ahead and jump into some of these questions. I'm so

glad that you're with us today. Could we just maybe just even

define a general sense of eating disorder? What is it? How do we

define it? How do I know that it's there? If I'm just a

general parent? What do I look out for that would be really

helpful?

And that's a great question. So there's various

types of eating disorders. Some of the more commonly known ones

are going to be binge eating disorder, anorexia nervosa,

bulimia nervosa, a newer emerging one is ARFID, which

stands for Avoidant Restrictive Food Intake Disorder. We're

gonna see different signs, symptoms, in each of these types

of eating disorders, of course, but you know, a big red flag for

parents can be sudden change in weight, especially as their teen

is growing and developing.

Either way.

Either way. Absolutely. You got it, too.

Yeah, great. clarifier I mean, it could be oh my gosh, my teen

has suddenly gained 50 pounds in the last six months or the

opposite way, oh my gosh, my teen is suddenly dropped 20

pounds yet they're still growing up vertically. Those can be big

red flags that parents and healthcare providers should be

looking out for, especially as they come in for annual visits,

if we see a sudden, huge decline on a growth curve, you know,

that that should be a huge red flag for for a care team and

often goes missed.

So just to break these up, just have some clarity. So,

two categories them is you know, we have anorexia, which is

defined by

So anorexia. Now we have specifics of the DSM-5

criteria that would be diagnosed by a medical provider therapist,

for instance. But to speak in generalities, you know, there's

generally going to be a preoccupation with maintaining a

low body weight or a desire to lose weight to a low body

weight, coupled with distorted beliefs and views towards food,

restrictive type behaviors towards foods. Bulimia is going

to be within the criteria diagnosed more as they might be

more of a normal body weight, not always. Um, but we're gonna

see periods of binging meaning eating large quantities of food

followed by some sort of compensatory measure to get rid

of that food, whether that be self induced vomiting, laxative

abuse. diet pills, diuretics.

Gotcha.

Yeah. So, all of them, you know, the commonality shared

there, of course, is just distorted beliefs, thoughts,

feelings towards food and body image. Whereas with binge eating

disorder, for example, there's not there's episodes of binge

eating, without any kind of compensatory measurement

followed afterwards, there's no purging, for instance,

Gotcha. So that's super helpful to separate them

out. If I'm a parent, what are some things that I'm just

looking for? I mean, my child's going to school, they're coming

home? How am I looking for little indicators? Is there a

change in attitude towards food? Is there different foods that

are I'm wanting to consume is high carbs? I mean, you maybe

some shed some light on that, Liz, if you could?

Yeah, absolutely. And a lot of it comes down to,

again, that subtype of of eating disorder of what we might be

looking for, if parents notice, like, I just went grocery

shopping, and all the food is now out of the missing out of

the pantry. That can be a big, big red flag for episodes of

binge eating. Or perhaps, you know, I noticed mannerisms at

the dinner table of my child really moving their food around

a lot, not -- taking small bites, just very, very different

behaviors towards towards their food than I maybe noticed

before. Coupled with you mentioned a great one, like

being more withdrawn, perhaps all of a sudden, they're self

isolating a lot more, their their mood is just not quite,

you know, it doesn't feel like my child anymore.

When we see a pattern of if we had some bulimia type

behavior, would there be a pattern of eating and then maybe

excusing themselves to the restroom right after? Or?

Absolutely,

yeah, there tends to be a lot of secrecy with that might be food

hiding? Yes, then if that that behavior after eating is purging

or self induced vomiting, absolutely excusing themselves

to go to the bathroom, taking very long showers, maybe going

on long walks after, after a meal. And you know, I always

tell parents, like listen to your gut, you know, as a parent,

we have this gut intuition. And if something just doesn't feel

right, you know, follow through on that.

Well, I'm wondering, in your experience, too, is that

I'm hearing a greater amount as this eating disorder becomes

more of an epidemic, if you will.

Absolutely, it is.

Is there more of a normalizing of it, like, Oh,

Mom, this is what the girls are doing? Are we eat less? Or we do

this? Or are you seeing any of this more normalizing of, of

eating patterns? Or, you know, dieting and trying to be thin?

And

Yeah, I mean, I think COVID brought I've had countless

of my patients tell me about I think a lot of this emerges from

social media, right of oh, how to not gain weight during COVID,

and how to be healthy and eat healthy during COVID. And I

think a lot of the eating disorders that have just spiked

over the last few years have been partly in response to these

messages that we're seeing in social media, and maybe started

out innocently enough. But with that, right cocktail of genetic

factors, personality traits, maybe comorbidity mental health

conditions, that it kind of creates this perfect storm for

the development of an eating disorder, because eating

disorders go beyond just food and body image issues, right? I

mean, they are psychological conditions.

Well, I really like your emphasis and that paradigm

shift, because I wonder if how many of us feel like, Oh, it's

just about what you put in your mouth? Yeah, it's much more

complicated.

It's much more complicated. And, you know, I

think that's good insights for parents to have. It's not just

about like, hey, just sit down and eat your food to your child.

That's, that's not the problem, right? I mean, it is in the

sense that they aren't eating and in a lot of cases, if we're

looking at more restrictive type eating disorders, but the

problem exists beyond just being able to sit and eat.

Just to shift shift gears a little bit. I'm so

fortunate to have you here as a dietitian, as a registered

dietitian, because I'd love for you to speak sometimes as a

therapist, as a psychotherapist myself, I'm like, Well, if we

could cognitively work it out, or we could rethink some of the

things which is great. I wonder if there's a piece about

literally, how is your body responding when you're either

cramming it full of carbs and overloading it or depriving it?

How's your mental clariety, how is your anxiety? I mean, from a

dietary point of view? How has a disordered eating really impact

your you physiologically cognitively? My question makes

sense.

Absolutely no. And this is a huge piece. I'm big on

education, yeah, dietitian, all my patients get education. But a

big one is talking about the complications, the metabolic,

emotional, physiological complications that occur from

eating disorders. So, you know, like I mentioned before, a lot

of my population tends to be more on the restrictive eating

behavior side of things, more of my my patients tend to have

anorexia. And with that, the effects of starvation, your

body's essentially, in a starved state. They're widespread, it's

affecting every body system. So you know, I really definitely

hone in on brain health, for instance, like you mentioned. So

imagine our brain relies on nutrients to maintain normal

function to think to process to have complex reasoning to manage

emotions. And when I'm depriving my brain of that adequate

nutrition, it can't provide it can't do all its brain function,

right? I mean, it just can't. And so we see higher increases

in, in reported anxiety levels, potentially increases in

depression levels, as that restriction worsens. We see, you

know, we mentioned before, is that self isolation, so there's

just limited capacity to really connect with other people when

I'm so depleted. Nutritionally?

Yeah. So that's some things to be really aware of as

a parent is this has, we need to look at it in a holistic way?

Oh, absolutely.

It's much more complicated, then it's just

Here, eat this, at these regular hours, there's hormonal effects,

there's control issues. I mean, there's a number of complexities

happening with the person who's really struggling with this.

Absolutely. That could be trauma that no one's aware of

that's happened. I mean, that's, that's a big piece for many.

Yeah. So if I'm a parent, and I have some

suspicions of my child doing this, what should I do to

support them? But like, do I immediately call a therapist? Do

I hide all the scales in the house? But what do we do if

we're a parent, and I'm just not sure what's happening with my

child,

I would say, first and foremost, if you have any kind

of intuition, something's not quite right around my child and

eating habits, get them evaluated, bring them in to meet

with a dietitian, with the therapists that are both skilled

and eating disorders, and additionally, a medical

provider, especially if we have concerns for, you know,

starvation type of behaviors, right? I mean, it can have life

threatening consequences. So yes, absolutely. Bring them in

and get them evaluated by the team of professionals that knows

what to look for. And that's a great place to start.

How do I, so we get them to help I do that. I mean,

let's really talk practically. My own imagine somebody who is

struggling with an eating disorder is probably a little

defended, a little bit guarded, struggling with anxiety and

depression. So it has multiple feelings. They might be

accessible to treatment, but they also might be especially

adolescents, resistant to parents. Nothing's wrong with

me. I don't want to do this. But how do I be supportive of my

child and get them in a positive way for us to get evaluated?

I'll tell you probably half the people that come to me

don't want to be there. And the first session when I assess

them, and they're open about it, and I totally respect that

openness and honesty, the sense of denial that there is a

problem is huge, right? Our brain doesn't really good job at

trying to defend our thoughts and our beliefs, even when they

become very distorted. In the case of eating disorders.

There's lots of cognitive distortions going on. And we

want to protect ourselves and say, like, this is normal. This

is rational. I don't know what everyone else is trying to tell

me. So yeah, that definitely happens. And I think it's the

parents responsibility to, to, you know, to still really

encourage this hey treatment's important and I need you to go

here, hey, if I have medical concerns for you, you're

underweight, you're passing out your heart rates potentially

lowered, because these are all can be absolute consequences of

restrictive eating disorders, that I'm going to bring them to

a doctor, even if they're kicking and screaming because

I'm worried about their medical safety. I don't see how it's

much different in terms of getting the right therapy

andnutritional restoration, it's I mean, you need to start

treatment takes a full team of professionals. It's not just one

person. And that team of professionals includes parents.

They're part of the treatment team.

Oh,

I love what you're saying. So just just to clarify, Liz, I

really appreciate what you're saying is that when it comes to

the safety, when it comes to basic safety needs, those should

be really non negotiables. For parents,

Absolutely.

Like, boy, your health is at risk or seeing this as a

potential, we have to go get you that assessment that care, that

can be done, if those are non negotiables. It can be done with

a tremendous amount of compassion. Right?

Absolutely. And compassion, I love that you use

that word. Compassion is so crucial, because often I see

parents reacting in more anger, right, which is a normal

response. If my kids not doing what I think they need to be I

get angry. We need to take a step back. And remember how much

of a mental struggle this is internally for your child,

whether or not they're telling you about it, it absolutely is.

And so showing that compassion that hey, I understand this is

tough for you. However, it's still really important and being

my other C, I love to mention is consistency, right? It's that

consistent message, day to day of treatment is important

getting you rehabilitated as important nutritionally

medically, emotionally,

I like to use the word empathy, empathy within the

midst of this compassion, because the have as a parent

taking an empathetic stance is, boy, if I'm you, and I'm going

through this, and it's not necessarily about the food, but

boy, this is a challenging time in your life. And I might be

feeling I'm wanting acceptance, or I might feeling rejected. I

mean, there's a lot of pressure on adolescents and young adults

these days with social media to look a certain way to have X

amount of friends to be performing and a certain level.

I just wonder, I mean, all that's contributing is as a

parent to take an empathetic stance, embraces them, and and

actually, it communicates. It's not just a thinking error.

Right

The eating disorder is much more complicated for the

child, the the young adult, then, here, let's just change

the way you're thinking about food.

Oh, yeah. I mean, that's one piece of the puzzle,

but it's with many other. So yeah, that's such a great point.

Yeah. Just a few more questions that some parents had,

Liz, if I'm a parent, and I suspect that this some sort of

struggle with food or an eating disorder is, how should I

respond as a parent? Do I change what I buy at the market? Do I

lock the cabinets up? Do I like, just go on a full Blitz? And,

you know, what is what should be my role as a parent? In this

whole process?

Absolutely. So parents are such a crucial part of the

treatment team. And so more involvement is always

recommended. You know, I have some parents, how much should I

if I'm going to make things worse, if I'm overly involved,

you know, I think the word involvement versus control or

you know, there's differentiate differentiating factors there,

right? We don't want to feel like we've taken over full

control of that child's life. I mean, in some cases, that

happens, but rather inserting yourself into the oversight of

meals, making sure that meal is getting eaten that's getting

prepared. I'm working with my child to plan balanced meals

that are being recommended by my dietician so that my child is

getting all the nutrients that their body needs to restore, its

its health. We mentioned before scales like absolutely, I always

instruct parents get the scales out of the house, it can be such

a ritualistic compulsive behavior for teens of measuring

their body weight. And when this is such a big piece of that

eating disorder, if they're continuing to have access to

things like scales at home, it's just going to delay and

potentially set them so far back in recovery, if they're tracking

that number, because part of you know, the nature of of some

eating disorder, this desire to maintain a low body weight.

I love that you're talking about that. So one is,

as a parent, we can take on some responsibilities. Consult with a

dietitian, like yourself to say, Hey, what are healthier meals I

can make at home? What are correct portions. What is that?

A healthy eating schedule? We could certainly role model that.

Yeah. So I am a big believer in meal planning

together parent and child sitting down, planning the meals

out for the week together where and it might be more on the

parent in the beginning than it is on the child and It might

shift as time goes on where the child takes a more active role

in that it's so individualized. However the the commonality is,

yeah, parents like it's you're so crucial to be helping with

this piece of getting these meals balanced so that your kids

getting all the right nutrients. And again, this is done with

assistance with your registered dietitian, it's no big crucial

part of the care process of how much does my child need to be

eating? How often you know what types of food groups and so

forth. And so that's, that's a huge thing. And

so if you're overwhelmed by it as a parent,

see, there's lots of people out there a registered dieticians

who have expertise in this field.

Yeah, this is not all on parents by themselves to have

to think up meal plans, and how much does my kid need? That's

where we rely on the expertise of a dietitian with eating

disorder experience to help with that. But yeah, meal planning is

huge. Having that food available in the house. Again,

everything's so individualized in the case of binging episodes,

we might need to remove some of those binge foods temporarily

from the house, if it's something we're working on

getting under control. Personally, I don't recommend

locking up cabinets. But it's not to say that in some cases

that's not needed for for certain populations.

Right. But it's such great informationLiz I really

appreciate that. Just a few more things I wanted to touch on is

that there's this You mentioned a psychological component to

this whole thing. I haven't touched a lot on about the

complexities of like a scale and seeing a number. And it gets

very convoluted because body dysmorphia, maybe talk a little

bit about that. If you're a parent, and you're saying, Well,

we're going to take the scales away, or why is the number

important to you. And you're trying to be rational about

this. You can talk about they're really in an irrational place

about

Oh, absolutely.

Yeah, talk a little bit about that. As a parent I

maybe I'm under estimating what level of when we have done Body

Dysmorphia stuff, at what level is there some irrationality

around it?

I mean, I've worked with clients where they're

checking their body weight 10 times a day, and even seeing an

ounce of go up on that scale is can create a complete meltdown

emotionally for them. And like I said, you know, that alone just

really emphasizes like how distorted those thoughts can be

towards body weight and even an ounce at half a pound something

minimal that an irrational thought we wouldn't registers

anything can be really significant in the moment for

that person. Yeah, I mean, scales, there's there tends to

be this like relationship that a lot of, of these patients have

with their scale. And it can be a really emotional thing, when

you take away the scale that can feel like a sense of like a

loss.

Because what did what does that number on the scale

represent you I like to use this relationship, I wonder, give us

some insight as a, as a parent of a child or some? What happens

if I step on that scale? And it's up or down? What happens to

me? What do I experience?

Yeah, and it's great question. And, you know, that

number generally represents my self worth as a human for a lot

of them. So, you know, I might have I always asked my patients,

do you have a goal in mind? What do you what's what's gonna make

you happy, because that tends to be where they equate, like, if I

could just reach this weight, I'll be happy, all my problems

will go away. And they truly believe it in that moment. And

so the interesting thing that happens is, hey, I meet that

goal, wait, maybe nothing magically changes, I don't,

suddenly my problems are not all gone. And I'm carefree. Guess

what happens I have a new goal weight in mind. And so this, it

just continues to perpetuate this obsession with continuing

to lose weight for a lot to where it can get really

dangerous. And furthermore, why that scale needs to go. So I

always instruct parents that, you know, we don't talk about

numbers. My care to the care team can be responsible for

managing the the weighing weigh ins of those patients, making

sure we're tracking for safety reasons how your weight is

progressing. But I'm not going to talk specifics with my

patients ever nor should parents nor should the medical team. And

so, you know, parents can be that advocate as well, for their

child's when they say go take them to the medical doctor and

say, Hey, we would like a blind weight, meaning I don't want

this weight to be discussed with my child. I don't want them to

see it. So maybe they need to step on the scale backwards.

Maybe I need to put a piece of paper in front of the value that

shows up on that scale. But it's such a crucial piece for and I

can't say blanket every eating disorder. You know, sometimes it

can be therapeutic to be involved in the weight

monitoring, but generally in a teen population, especially in

earlier stages of treatment, or when we're working on weight

restoration, seeing that number is just going to set them so far

back in recovery and potentially cause a full on relapse.

So, what we're hearing, I'm so grateful for

this, Liz is that, really, if I'm a parent, please reach out

and get some professional help, because people like you get have

so much experience that they're going to shed some light on

things I'm not even considering as a parent.

Absolutely. And, you know, I think parents like

because it is so much information that I don't just

have taught to me in parenting school, right? I mean, you have

to seek this information out. And being an advocate for your

child is crucial. And your care team is there to help educate

you on that. But as parents as well, I always encouraged them,

read books, join support groups, look at articles online, you

know, immerse yourself in educating and getting more

familiar with what really are eating disorders,

you mentioned before is that many people might think

that this is this primarily fits a certain population, that this

is, oh, this is an upper middle white class kind of issue. Maybe

it My question is, how is this eating disorders affecting

diverse populations? In your experience?

Yeah, and that's such a great question. You know, I,

to this day, have people tell me like, oh, that's only like a

rich white person illness, right. And, you know, I want to

pull my hair out when I hear that because it's just not true.

We're seeing such a growing emergence, especially in

subpopulations that experience more discrimination and

microaggressions. And within their communities. So like, the

LGBTQIA community, for instance, very prevalent in African

American communities, and Asian American communities and native

communities. So it even says, don't discriminate by, by your

race, by your ethnicity, it's, it's probably more that we're

just becoming more aware and normalizing this for a lot of

different populations.

You know, there's lots of research out there, but

really having us having an awareness that, you know, if

it's the BIPOC community, if it's the LGBTQIA plus community,

I mean, even young children, if we don't really consider what is

the impact, especially the anxiety, the depression, because

those communities are actually seeing higher rates of eating

disorders than I think many of us are even estimating

that they're experiencing.

I definitely believe that I think it's just, there's

poor access to care for a lot of people or there's that word

shame. You mentioned earlier, that can be huge that, you know,

I, maybe I went to a doctor and said, I, you know, struggling

with food, and unfortunately heard this too many times that

doctor might respond on your, your weight is normal, you don't

have an eating disorder, or boys don't get eating disorders. I

mean, I've heard these things. And it's so invalidating for

that person. And more than likely, they're probably not

going to share that again, with someone because they've just

been made to feel shameful for even bringing it up or that

they're, they're wrong for feeling that way. And so, you

know, I think that definitely contributes to a lot of under

diagnosis as well.

So we we've been talking today Liz about focusing

on adolescents and young adults, primarily, I do want to

highlight we've also talked about really systems and roles

of families and parents. I know even in myself, I'm taking away

right now. Well, how can I really even look at maybe my my

own as a parent? My own relationship with

food?

Yeah, that's a big one.

Yeah.

And then what does that mean for my children and my own

relationship with food? What What would you say to parents

when it comes to?

Yeah, so parents, like, you know, I have a whole

general do's and don'ts of communication when it comes to

eating disorder talk in the household. And a big, big one is

really taking an inside look at my own body image as a parent,

how am I demonstrating or my relationship with my own body?

Am I saying things like, Oh, I'm, you know, I shouldn't eat

that. It's, you know, I don't need that. I'm looking to lose

weight, whatever comments like this. While parents might think,

well, it's not directed at my kid, I'm talking towards myself,

but we're not seeing as our kids are really taking what they're

hearing and internalizing it, and attributing that to their

own body image, and their relationship and, and thoughts

towards food. And this is not to say that parents are the cause

of eating disorders. I want to make that clear because that's

in the past. Way back when is what was said that all parents

causing eating disorder that's not the case at all, however, as

parents, we can illustrate healthy relationships with our

own food, body image to be good role models for our kids

struggling with the same thing to help teach them a different

way of thinking. You know, there's interesting statistics

showing that the body image, you know, poor body image and in

mothers has a huge impact in the perceived body image of their

child. So we know there's a definite relationship there,

I

think I saw a statistic was actually almost 34% was linked

to hereditary.

Yes, yeah. genetics are big eating disorders.

Definitely

talking about a transgenerational like a thing

tied to anxiety.

Definitely. Yeah.

Liz, this has been so helpful. I just like to, you

know, sort of, as we close this out, is there anything that

you'd really love for parents to take away with them, like, if

you'll leave with a few things here, here's what I want you to

leave with.

A big one for me, really, that I love to just

educate anyone on is let's try to remove some of that food

labeling talk that we all tend to do, we're all maybe guilty of

it, right? But labels such as good, bad, healthy, unhealthy,

and instead trying, I always try to emphasize more neutral

language as it surrounds to food. Because a lot of times

what happens if I label a certain food is bad, and now I'm

eating that food. Now, I've become inherently bad myself for

consuming that food. And it can play a big role on my own, you

know, perception of myself as a person, my self worth my value.

And so, you know, trying to instead focus on Hey, what

nutrients can that food provide me? You know, again, I'm big on

education. So I love teaching my clients about food groups, and

what we get from those food groups. And when we're choosing

to eat, maybe we do want a doughnut for that meal. And all

food fits in my philosophy of working with my clients, like,

what does that doughnut provide us? In that that instance? Can

it provide some nutrients, not saying I would recommend

doughnuts every day for every meal by any means because they

lack other nutrients. But the point is, we're trying to

neutralize and remove those labels, because that's such a

big part of, of the eating disorder have rules set around

what I can and cannot eat. And if I disobey those rules, those

feelings of shame of guilt of potentially worsening anxiety,

depression. And another big one, too, is, you know, just being

mindful of what we're talking about in the home environment,

right? We talked about, you know, trying to avoid language,

negative language around our own bodies. But that's also talking

about in general, I, I tell parents to avoid lots of

conversations about diets about weight loss about exercise

plans, again, may be seemingly harmless sounding for many. But

what's happening when our teen is hearing these messages about

so and so's on a diet, and they're losing all this weight,

and they look so great, especially for a teen with, with

eating disorder, that's internalized as there's a lot

that starts clicking in their head when they hear these things

of, oh, maybe I should be on a diet, if that person's losing

weight, maybe I need to lose weight. And so while we can't

control what comes out of everyone's mouth, if we can

control some of that dialogue at home, but if we can minimize the

language that can be potentially triggering for our teens,

triggering meaning, that might increase my urge to want to

restrict to more food to go over exercise, to purge, whatever

that might fit, that behavior might look like for your teen

and it's different for all these types of conversations can

definitely have a huge impact on on those types of urges and

triggering them.

Fantastic, great takeaways. Lis super, super

informative, helpful. There's professional help out there

There is, yeah,

Just like you and certainly Doorways offers an

opportunity. If a parent had a question, could they send you an

email or what's a good way if a parent had a question about

this? Specifically, I'd like to reach out to Liz

Absolutely. I would say you know, find a location

that's going to work for you first and foremost, I I'm in

central Phoenix area. I would love to work with anyone that

has questions but yeah, reach out to Doorways Counseling

Center, we're in Phoenix or find other eating disorder treatment

centers if, if that's what you need based on where you live.

But yeah, the takeaway is, is get the help that your teen

needs sooner than later.

And this podcast is a good start to getting some

information. Do you Would you have any book recommendations or

any resources that you tend to give to parents Hopefully top

your head yes,

yeah, I love as part of the educating piece I love

parents to get immersed in that. So depending on what their child

is maybe struggling with I do have some favorites that I like

parents to read. You know, there's a great one written by

two dieticians about how to nourish your child through an

eating disorder that really kind of gets into the specifics of of

helping with the basics of meal planning and emphasizing the

importance of of finishing those meals. And just kind of giving

parents that toolkit,

What's the name of the book?

"How to Nourish Your Child Through an Eating

Disorder."

"How to Nourish Your Child Through an Eating

Disorder"?

Yeah, using the plate by plate approach that I'm a big

believer in myself, I really love Jenny Schaefer is actually

a recovered anorexic patient that has written several books

that are fantastic, especially to get into the mindset of

someone who had struggled with an eating disorder and is now on

the side of recovery, and can reflect back on her journey and

provide hope for those that maybe aren't quite there yet

that there is light at the end of the tunnel. It's a long

process. So I love a lot of her books, "Life Without ED" is

fantastic. For the parents that like to get real into the

complexities of all the medical consequences of eating

disorders, you know, I have a plethora of books that I

recommend for for that as well.

Great. And maybe we'll put some of those resources up

on the website. Yeah. Yeah, Liz, thanks so much for being with

us.

Thank you for having me.

This is just a incredibly relevant topic. And

They are, they absolutely are.

as parents everywhere, and just as even as caring people, this

is an ever growing issue. And it's tied to anxiety,

depression, I mean, we're seeing all sorts of ramifications of

suicidality, it's all connected. And so if we can have effective

treatment for part of this, and I just want to leave parents

Great. Well, thanks for your time today. I want to

with this thought of the relationship and establishing

say thanks for joining us. Please subscribe wherever you

access podcasts. If you have any questions for us. We'd love to

those secure relationships are really a key essential in this

hear from you submit those at askatherapist@embarkbh.com You

whole treatment process. Parents are an essential part of the

can also go to Doorways arizona.com To access the

information. So on behalf of Liz and myself, thank you for

treatment team process.