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Eating Disorders: How Parents can Support their Child
Episode 229th July 2022 • Roadmap to Joy: A Mental Health Podcast • Embark Behavioral Heatlh
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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:

Books:

Videos:

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:

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

Transcripts

Rob Gent:

Well welcome everybody to Roadmap to Joy. Super, super

Rob Gent:

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

Rob Gent:

registered dietitian with an expertise in eating disorders.

Rob Gent:

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

Rob Gent:

prevalent thing in our society.

Liz Lees:

It is.

Rob Gent:

Holy cow.

Liz Lees:

It absolutely is.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

just talk a little bit about where you work would be

Rob Gent:

fantastic.

Liz Lees:

Yeah, absolutely. Yeah. So doorways Counseling

Liz Lees:

Center is a outpatient mental health clinic specializing in

Liz Lees:

adolescent care. So specifically there, the majority of my

Liz Lees:

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

Liz Lees:

suffering from various types of eating disorders.

Rob Gent:

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

Liz Lees:

Yep. Located right in central Phoenix.

Rob Gent:

Oh, fantastic.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

about that,

Liz Lees:

Yes. Not emergency department, not anything else.

Liz Lees:

In the context of today.

Rob Gent:

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

Rob Gent:

really stands for eating disorder. And some of the facts

Rob Gent:

just the statistics are pretty staggering. But eating disorder

Rob Gent:

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

Rob Gent:

surprising to you, Liz?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

such a lack of knowledge out there in our general population

Liz Lees:

within health care providers even and so for such a high

Liz Lees:

number, you would think there would be a lot more

Liz Lees:

understanding of it.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

affected by an eating disorder, nearly 30 million Americans will

Rob Gent:

have an eating disorder in their lifetime.

Liz Lees:

Wow. It's a big number.

Rob Gent:

30 million.

Liz Lees:

Wow.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

disorder.

Liz Lees:

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

Liz Lees:

moved on to the number two highest cause of mortality

Liz Lees:

within mental health conditions.

Rob Gent:

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

Liz Lees:

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

Liz Lees:

wow,

Rob Gent:

One person every hour, basically, as the direct result

Rob Gent:

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

Rob Gent:

Because this this affects us. The economic cost of eating

Rob Gent:

disorders is nearly $65 billion a year

Liz Lees:

Sheesh, it's a big number.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

few stats, over 50% of individuals with eating

Rob Gent:

disorders meet criteria for depression and anxiety.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

CO comorbidities of depression, anxiety, other mood disorders.

Liz Lees:

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

Liz Lees:

how they're treated.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

huge part of the whole treatment process.

Liz Lees:

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

Liz Lees:

taboo with with, especially within certain maybe cultures or

Liz Lees:

family dynamics about even talking about. E specially maybe

Liz Lees:

even looking in male populations.

Rob Gent:

Yes,

Liz Lees:

So underserved as far as getting treatment and a lot

Liz Lees:

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

Liz Lees:

of that comes down to that word shame.

Liz Lees:

issue.

Liz Lees:

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

Liz Lees:

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

Rob Gent:

It's not true.

Liz Lees:

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

Liz Lees:

emergence in subpopulations. I mean, eating disorders do not

Liz Lees:

discriminate by socioeconomic status, race, gender, sexual

Liz Lees:

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

Liz Lees:

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

Liz Lees:

necessarily this bigger emergence of it happening, but

Liz Lees:

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

Liz Lees:

bit more than we used to.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

received treatment.

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

field.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

aren't discriminating by my economic privileges or

Liz Lees:

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

Liz Lees:

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

Liz Lees:

lot of families to undergo treatments and get that

Liz Lees:

specialized care team.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

specialization important? Especially if I'm a generalized

Rob Gent:

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

Rob Gent:

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

Rob Gent:

anxiety depression, is it is a specialization important is

Rob Gent:

talking about that specific issue is addressing that issue

Rob Gent:

important from your standpoint?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

general pediatrician? Or would I go and find a pediatric

Liz Lees:

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

Liz Lees:

same thing with eating disorders, you need a team that

Liz Lees:

truly understands the complexities that are an eating

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

understand the condition. So absolutely. A specialized care

Liz Lees:

team is important.

Rob Gent:

Similar to Doorways, yeah,

Liz Lees:

Absolutely.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

helpful?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

are going to be binge eating disorder, anorexia nervosa,

Liz Lees:

bulimia nervosa, a newer emerging one is ARFID, which

Liz Lees:

stands for Avoidant Restrictive Food Intake Disorder. We're

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

is growing and developing.

Rob Gent:

Either way.

Liz Lees:

Either way. Absolutely. You got it, too.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

red flags that parents and healthcare providers should be

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

often goes missed.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

defined by

Liz Lees:

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

Liz Lees:

criteria that would be diagnosed by a medical provider therapist,

Liz Lees:

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

Liz Lees:

generally going to be a preoccupation with maintaining a

Liz Lees:

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

Liz Lees:

weight, coupled with distorted beliefs and views towards food,

Liz Lees:

restrictive type behaviors towards foods. Bulimia is going

Liz Lees:

to be within the criteria diagnosed more as they might be

Liz Lees:

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

Liz Lees:

see periods of binging meaning eating large quantities of food

Liz Lees:

followed by some sort of compensatory measure to get rid

Liz Lees:

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

Liz Lees:

abuse. diet pills, diuretics.

Rob Gent:

Gotcha.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

feelings towards food and body image. Whereas with binge eating

Liz Lees:

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

Liz Lees:

eating, without any kind of compensatory measurement

Liz Lees:

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

Rob Gent:

Gotcha. So that's super helpful to separate them

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

change in attitude towards food? Is there different foods that

Rob Gent:

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

Rob Gent:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

the dinner table of my child really moving their food around

Liz Lees:

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

Liz Lees:

behaviors towards towards their food than I maybe noticed

Liz Lees:

before. Coupled with you mentioned a great one, like

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

excusing themselves to the restroom right after? Or?

Liz Lees:

Absolutely,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

or self induced vomiting, absolutely excusing themselves

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

right, you know, follow through on that.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

more of an epidemic, if you will.

Liz Lees:

Absolutely, it is.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

And

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

think a lot of the eating disorders that have just spiked

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

factors, personality traits, maybe comorbidity mental health

Liz Lees:

conditions, that it kind of creates this perfect storm for

Liz Lees:

the development of an eating disorder, because eating

Liz Lees:

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

Liz Lees:

mean, they are psychological conditions.

Rob Gent:

Well, I really like your emphasis and that paradigm

Rob Gent:

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

Rob Gent:

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

Rob Gent:

complicated.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

looking at more restrictive type eating disorders, but the

Liz Lees:

problem exists beyond just being able to sit and eat.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

your you physiologically cognitively? My question makes

Rob Gent:

sense.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

big one is talking about the complications, the metabolic,

Liz Lees:

emotional, physiological complications that occur from

Liz Lees:

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

Liz Lees:

of my population tends to be more on the restrictive eating

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

imagine our brain relies on nutrients to maintain normal

Liz Lees:

function to think to process to have complex reasoning to manage

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

in, in reported anxiety levels, potentially increases in

Liz Lees:

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

Liz Lees:

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

Liz Lees:

just limited capacity to really connect with other people when

Liz Lees:

I'm so depleted. Nutritionally?

Rob Gent:

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

Rob Gent:

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

Liz Lees:

Oh, absolutely.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

child,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

with a dietitian, with the therapists that are both skilled

Liz Lees:

and eating disorders, and additionally, a medical

Liz Lees:

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

Liz Lees:

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

Liz Lees:

threatening consequences. So yes, absolutely. Bring them in

Liz Lees:

and get them evaluated by the team of professionals that knows

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

struggling with an eating disorder is probably a little

Rob Gent:

defended, a little bit guarded, struggling with anxiety and

Rob Gent:

depression. So it has multiple feelings. They might be

Rob Gent:

accessible to treatment, but they also might be especially

Rob Gent:

adolescents, resistant to parents. Nothing's wrong with

Rob Gent:

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

Rob Gent:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

become very distorted. In the case of eating disorders.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

underweight, you're passing out your heart rates potentially

Liz Lees:

lowered, because these are all can be absolute consequences of

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

much different in terms of getting the right therapy

Liz Lees:

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

Liz Lees:

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

Liz Lees:

person. And that team of professionals includes parents.

Liz Lees:

They're part of the treatment team.

Rob Gent:

Oh,

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

be really non negotiables. For parents,

Liz Lees:

Absolutely.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

a tremendous amount of compassion. Right?

Liz Lees:

Absolutely. And compassion, I love that you use

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

of a mental struggle this is internally for your child,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

consistent message, day to day of treatment is important

Liz Lees:

getting you rehabilitated as important nutritionally

Liz Lees:

medically, emotionally,

Rob Gent:

I like to use the word empathy, empathy within the

Rob Gent:

midst of this compassion, because the have as a parent

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

amount of friends to be performing and a certain level.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Liz Lees:

Right

Rob Gent:

The eating disorder is much more complicated for the

Rob Gent:

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

Rob Gent:

the way you're thinking about food.

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

whole process?

Liz Lees:

Absolutely. So parents are such a crucial part of the

Liz Lees:

treatment team. And so more involvement is always

Liz Lees:

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

Liz Lees:

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

Liz Lees:

you know, I think the word involvement versus control or

Liz Lees:

you know, there's differentiate differentiating factors there,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

happens, but rather inserting yourself into the oversight of

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

a ritualistic compulsive behavior for teens of measuring

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Liz Lees:

Yeah. So I am a big believer in meal planning

Liz Lees:

together parent and child sitting down, planning the meals

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

this piece of getting these meals balanced so that your kids

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

who have expertise in this field.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

where we rely on the expertise of a dietitian with eating

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

we might need to remove some of those binge foods temporarily

Liz Lees:

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

Liz Lees:

getting under control. Personally, I don't recommend

Liz Lees:

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

Liz Lees:

that's not needed for for certain populations.

Rob Gent:

Right. But it's such great informationLiz I really

Rob Gent:

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

Rob Gent:

that there's this You mentioned a psychological component to

Rob Gent:

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

Rob Gent:

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

Rob Gent:

very convoluted because body dysmorphia, maybe talk a little

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

about

Liz Lees:

Oh, absolutely.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

Dysmorphia stuff, at what level is there some irrationality

Rob Gent:

around it?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

really emphasizes like how distorted those thoughts can be

Liz Lees:

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

Liz Lees:

minimal that an irrational thought we wouldn't registers

Liz Lees:

anything can be really significant in the moment for

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

loss.

Rob Gent:

Because what did what does that number on the scale

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

me? What do I experience?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

just continues to perpetuate this obsession with continuing

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

managing the the weighing weigh ins of those patients, making

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

can be therapeutic to be involved in the weight

Liz Lees:

monitoring, but generally in a teen population, especially in

Liz Lees:

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

Liz Lees:

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

Liz Lees:

back in recovery and potentially cause a full on relapse.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

things I'm not even considering as a parent.

Liz Lees:

Absolutely. And, you know, I think parents like

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

know, immerse yourself in educating and getting more

Liz Lees:

familiar with what really are eating disorders,

Rob Gent:

you mentioned before is that many people might think

Rob Gent:

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

Rob Gent:

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

Rob Gent:

it My question is, how is this eating disorders affecting

Rob Gent:

diverse populations? In your experience?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

We're seeing such a growing emergence, especially in

Liz Lees:

subpopulations that experience more discrimination and

Liz Lees:

microaggressions. And within their communities. So like, the

Liz Lees:

LGBTQIA community, for instance, very prevalent in African

Liz Lees:

American communities, and Asian American communities and native

Liz Lees:

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

Liz Lees:

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

Liz Lees:

just becoming more aware and normalizing this for a lot of

Liz Lees:

different populations.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

the impact, especially the anxiety, the depression, because

Rob Gent:

those communities are actually seeing higher rates of eating

Rob Gent:

disorders than I think many of us are even estimating

Rob Gent:

that they're experiencing.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

with food, and unfortunately heard this too many times that

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

diagnosis as well.

Rob Gent:

So we we've been talking today Liz about focusing

Rob Gent:

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

Rob Gent:

highlight we've also talked about really systems and roles

Rob Gent:

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

Rob Gent:

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

Rob Gent:

own as a parent? My own relationship with

Rob Gent:

food?

Liz Lees:

Yeah, that's a big one.

Rob Gent:

Yeah.

Rob Gent:

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

Rob Gent:

relationship with food? What What would you say to parents

Rob Gent:

when it comes to?

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

hearing and internalizing it, and attributing that to their

Liz Lees:

own body image, and their relationship and, and thoughts

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

parents, we can illustrate healthy relationships with our

Liz Lees:

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

Liz Lees:

struggling with the same thing to help teach them a different

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

I

Rob Gent:

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

Rob Gent:

to hereditary.

Liz Lees:

Yes, yeah. genetics are big eating disorders.

Liz Lees:

Definitely

Rob Gent:

talking about a transgenerational like a thing

Rob Gent:

tied to anxiety.

Liz Lees:

Definitely. Yeah.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Rob Gent:

leave with.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

and instead trying, I always try to emphasize more neutral

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

it provide some nutrients, not saying I would recommend

Liz Lees:

doughnuts every day for every meal by any means because they

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

feelings of shame of guilt of potentially worsening anxiety,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

conversations about diets about weight loss about exercise

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

that starts clicking in their head when they hear these things

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

language that can be potentially triggering for our teens,

Liz Lees:

triggering meaning, that might increase my urge to want to

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

triggering them.

Rob Gent:

Fantastic, great takeaways. Lis super, super

Rob Gent:

informative, helpful. There's professional help out there

Liz Lees:

There is, yeah,

Rob Gent:

Just like you and certainly Doorways offers an

Rob Gent:

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

Rob Gent:

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

Rob Gent:

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

Liz Lees:

Absolutely. I would say you know, find a location

Liz Lees:

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

Liz Lees:

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

Liz Lees:

has questions but yeah, reach out to Doorways Counseling

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

needs sooner than later.

Rob Gent:

And this podcast is a good start to getting some

Rob Gent:

information. Do you Would you have any book recommendations or

Rob Gent:

any resources that you tend to give to parents Hopefully top

Rob Gent:

your head yes,

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

two dieticians about how to nourish your child through an

Liz Lees:

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

Liz Lees:

helping with the basics of meal planning and emphasizing the

Liz Lees:

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

Liz Lees:

parents that toolkit,

Rob Gent:

What's the name of the book?

Liz Lees:

"How to Nourish Your Child Through an Eating

Liz Lees:

Disorder."

Rob Gent:

"How to Nourish Your Child Through an Eating

Rob Gent:

Disorder"?

Liz Lees:

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

Liz Lees:

believer in myself, I really love Jenny Schaefer is actually

Liz Lees:

a recovered anorexic patient that has written several books

Liz Lees:

that are fantastic, especially to get into the mindset of

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

complexities of all the medical consequences of eating

Liz Lees:

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

Liz Lees:

recommend for for that as well.

Rob Gent:

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

Rob Gent:

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

Rob Gent:

us.

Liz Lees:

Thank you for having me.

Rob Gent:

This is just a incredibly relevant topic. And

Liz Lees:

They are, they absolutely are.

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Liz Lees:

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

Rob Gent:

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

Rob Gent:

with this thought of the relationship and establishing

Rob Gent:

say thanks for joining us. Please subscribe wherever you

Rob Gent:

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

Rob Gent:

those secure relationships are really a key essential in this

Rob Gent:

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

Rob Gent:

whole treatment process. Parents are an essential part of the

Rob Gent:

can also go to Doorways arizona.com To access the

Rob Gent:

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

Rob Gent:

treatment team process.

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