transcript

Speaker 1:
[00:00] Eating disorders don't always look the way we expect. As parents, sometimes the hardest part isn't noticing something feels off, it's figuring out what to do next. Early support can make a real difference, but finding help is often confusing, slow, or disruptive. That's why I'm excited to tell you about Equip, a virtual eating disorder treatment program that helps your child recover at home with a full care team, and support for you as parents every step of the way. Equip treats all eating disorders, works with all ages, has no wait list, and is covered by insurance in all 50 states. If you're worried about your child and don't know where to start, visit equip.health.goodeinside to learn more about Equip's eating disorder treatment. That's equip.health.goodeinside. Welcome to The InBetween Years from Goodeinside. I'm Dr. Sheryl. If you've ever had the thought, is this a thing or am I overreacting? You're already in the moment this episode is about. In this case, the topic is food. A kid who suddenly cares a lot about eating clean. A teen who skips dessert without a second thought. A shift that's subtle enough to explain a way, but persistent enough that you keep thinking about it. So much of what kids are picking up right now actually sounds like discipline or health or doing the right thing, which means a lot of parents hesitate. They wait. They try to figure out if they're making too big a deal of something that might just pass. But as you'll hear in this conversation, by the time you're asking those questions out loud, there's usually something worth paying attention to. Eating disorders and disordered eating are far more common than most of us realize. They affect an estimated 30 million American men and women over the course of their lifetimes. One in five teens struggle with unhealthy thoughts or behaviors around food or their bodies. Which means if you're listening to this, this topic probably touches your life. This conversation originally aired on Good Inside with Dr. Becky, but it's so packed with insight and refreshing honesty that I wanted to make sure you heard it. Dr. Becky talks to Dr. Erin Parks, a clinical psychologist who works closely with teens and families around eating disorders. Before we get into it, I want to be transparent about one thing. Equip Health, where Dr. Parks works, is a sponsor of this podcast this season. Also, this is exactly the kind of conversation I want parents to hear on this podcast. It's grounded, it's practical, and it helps you move out of that stuck place of, do I act or do I wait? Let's go.

Speaker 2:
[03:10] Okay, so many things I want to ask you, but I just want to ground this conversation around eating disorders, disordered eating, with what you're really seeing right now with families, teens, younger kids around food. What is showing up most and what's most pressing, most relevant right now?

Speaker 3:
[03:29] I think the two things is that, first of all, it's increasing and more of it. And I hear parents worrying about either their child's picky eating. Is this a problem? Is this not a problem? It seems to be getting worse. Or about how their kids are feeling about their bodies and trying to eat healthier and control what they eat. The parents are asking me, should I worry or should I be celebrating? These are the two things I'm probably hearing the most.

Speaker 2:
[03:55] Increase in picky eating.

Speaker 3:
[03:57] Increase in picky eating.

Speaker 2:
[03:58] And in eating disorders?

Speaker 3:
[03:59] And in eating disorders. The rates of eating disorders had been steady for about a hundred years. And since 2020 have been going up and up.

Speaker 2:
[04:07] And then this other category of things, not to say that there's not overlap. I just want to see if I'm getting this right, Tamir. Back is there's this category of like, my kid wants to eat healthier and is healthy. Something to celebrate is healthy. Sometimes a cover for control or rigidity. Is that kind of the debate, the space you're seeing a lot of as well?

Speaker 3:
[04:25] Exactly. Because there's so much content coming out right now about the correct way to eat, the correct way to feed your kid. And I'm having parents say to me, my kid is freaking out because they're like, if kale is healthier than spinach, should I not eat spinach and only eat kale? And they want to do the right thing as parents. And then the kids want to do the right thing as kids. And yet, what is right is very much an air quotes because there is no one right way to eat.

Speaker 2:
[04:51] I want to actually take what you said in the categories them and maybe jump into them one at a time. Let's start with what you just ended with. What are healthy eating or rules around eating? One of the things I think about a lot is morality around eating. I always think with parents, it's like morality is often the thing we want to avoid. What are the good foods? Is it kale and spinach or is it no carb or no this or fat? There's always some latest thing. And so, when a parent comes to you and they're like, is this something I should be concerned about or how should I intervene? Just walk me through. If I'm saying that to you, I'm seeing my kid come. I don't buy that anymore and this isn't good and I read this thing online. I saw this thing on TikTok. My friends aren't eating this food anymore. And I'm thinking, okay, is this a good thing? Is my kid becoming more empowered? Is this a concerning thing? Just talk to me.

Speaker 3:
[05:39] By the time a parent asks me, even if it's just on the soccer field, is this a problem? Answers almost always yes. I really can count on one hand how many times the answer is no. There's something about us as parents that when our gut says something is off about food, we don't listen to it right away. Because we're consuming the same diet culture. We've been drinking from this fountain of look different, look younger, be smaller since we were also born. When we see these behaviors in our kid, our gut says something's wrong, and then we start saying, okay, it's probably just a phase. Probably making too big of a deal out of it. By the time I finally say it out loud to someone, the answer is yes. Yes, you should be trusting your gut. Yes, something is wrong.

Speaker 2:
[06:22] Yeah. My guess is also it's not always a binary. No, it's not a problem. Yes, it is a problem. Hey, there's something rising to the level of your gut thing. You're thinking about it. You're wondering about it. Let's just be more curious about it. Let's look into that together as opposed to either or.

Speaker 3:
[06:37] Exactly. If your child is saying, I want to eat healthier, and what that looks like is they start eating a wider variety of food. They start eating what you are eating at dinner. They start ordering new things on the menu when you go out to a restaurant. That probably doesn't make you worry, and that is a form of eating healthier. But when your child says they want to eat healthier, and they're no longer eating birthday cake at their cousin's birthday party, they are stopping eating their favorite foods, you're concerned they might be losing weight. That's when your gut is saying, wait, this eating healthier isn't a good thing. Your gut naturally goes off when you're picking up on them taking away things they used to do instead of simply adding.

Speaker 2:
[07:23] I'm picturing this parent with this kid. What comes next? Let's say a parent's thinking, okay, this whole shift is maybe under the cover. It's been labeled healthy, but there's something in me saying, I don't know, seems a little different from just that. Do I just notice for a couple of weeks? Do I collect some kind of data? Do I talk to my kid right away? If I do, what would that be? I'm going to put out another option on, do I say, I made a new appointment with a therapist and a nutritionist and you need to do that? Like how, what are the next steps?

Speaker 3:
[07:54] I would talk about it frequently and I would start now because it's something that all of us are constantly receiving information about how we should eat, how our bodies should look. And so it can also be a constant conversation in your home. So when your kid tells you they want to be healthier, I usually ask, well, tell me what that means. I'd love to help. We all want to be healthy. Healthier can mean going to bed at an earlier time, which is usually not what a teenager means when they say they want to eat healthier or be healthier. But reminding people that eating healthier is one aspect of health, and seeing is health what they're really after. I also like to ask them why. And I will hear things like, oh, I want to be faster at my sport or, well, I don't really know, but everyone's just, I mean, I should, shouldn't I? And that tells me something too. This I should, they're already shoulding themselves, they're already deciding that there's a good way to be and a bad way to be, and they think that eating a certain way, and it goes to your earlier point around the morality of food. And we need, I mean, I am a human who grew up in America, and a woman who's trying to embrace aging while not wanting to age, right? So I get the mixed messages that we all receive. But it's really, really difficult. And we accidentally say, I ate well, I ate poorly. I'm going to eat so poorly at the Super Bowl party, or I ate bad at the party. And so kids are around this moralization. And the behavior that they claim to want, like eat healthier, be healthier, is sometimes about trying to be perfect, to be better, find a binary that doesn't really exist.

Speaker 2:
[09:31] I just want to double click on this morality thing, because I know I've talked to parents who will say to me, and I'm sure you hear this all the time, but sugar is bad. But my kid doesn't have celiac, but gluten is bad. Gluten leads to inflammation. And I'm not here to debate any of those truths, but I'm sure that comes up a lot, where how do I figure out food and morality, especially if there are families and adults who really do believe, and maybe with good data, but why can't we talk about things as good or bad if there's certain data or signs to support that? How do you manage? I'm sure, and do you see that?

Speaker 3:
[10:11] I see it constantly. I mean, I live in Southern California. I could land on no sugar and no gluten. It's hard. I really, really personally struggle with it because I remember the 90s when bagels were a healthy breakfast item, and I miss it. My 14-year-old son came home, and he's newly at high school, and I can feel him picking some stuff up, and he has been more cautious around the sugar. So I asked him, I'm like, Max, what's going on here? He's like, I know of friends who just don't eat sugar. Yeah. You seem to feed us so much sugar. I'm like, you're welcome. I would like to hear it. Thank you. No, but kids want to do the right thing. So when I talk to other kids or parents about it, I remind them that while you are still developing, the number one thing you need is calories, period. And where are calories? They're in sugar. They're in carbs. That's where calories are. If you were anemic, I would be figuring out how to get you more iron. But what you are doing is going through growth spurts. They have so much movement between walking to classes and all the activities they're in and the sports. And they are growing. So what they need is calories. So the healthiest thing is calories and the easiest way to get that for them is carbs and sugar. If as a family, you are deciding to be gluten free or sugar free, there are all sorts of different ways to feed your kids. We do a lot of cancer metaphors in the eating disorder community. And I like to remind people that we would never give our child poison unless they had cancer and needed chemotherapy. So similarly, if in your household, you are like, we don't eat gluten or we don't eat sugar, but I'm going to make this change because my child now needs something that is different because they've developed an eating disorder or their disordered eating is making us worried about their health.

Speaker 2:
[11:56] I think that's really helpful. And one more level practical for the parents who are thinking, how do we manage a situation actively where it's true, my kid notices I'm not eating a certain thing, but I don't want that to be fully absorbed by them. Like what language do you recommend people use or what type of conversation starters?

Speaker 3:
[12:14] I think it's two things. Sometimes it's what you say and sometimes it's adjusting your behaviors. My child once saw me not finish a milkshake and I heard about it for a month. He knows that I have struggled with disordered eating before and eating disorder before and it made him hyper aware. I had no idea that he knew any of these things, that he even paid attention to what I did for a living. So they're always observing even when we think they aren't. So sometimes the solution is to talk to them about it and say, hey, I use the sports metaphors as well. You're going to have kids on your soccer team who have knee issues. They're going to do stretches that you don't do before and after practice. That kind of stinks for them. They have to spend these extra 30 minutes doing this and that. That is what they have to do because of their knee issue. Well, maybe there are people in our household who eat different for different reasons. Maybe dad is watching his cholesterol for health reasons, and so he has eliminated some foods. That's what he has to do. Though sometimes the solution is also examining your own food habits and the ways in which they're communicating things. You don't want your kids absorbing.

Speaker 2:
[13:17] I just want to say, Erin, I really love the very reality-based part of that answer. And there are times when, yes, we can label it to our kids. You're right, I'm not eating this, and I have my reasons. And look at our family in general. We believe that the way I do things shouldn't always be the way you do things. We actually love the way you guys do things differently as kids. And then there's other times where it is true. If you never eat certain types of food or if it feels very rigid, that behavior sometimes speaks louder than anything we say. And if you have a kid who's especially observant or especially people pleasing or especially looking at me all the time and becoming rigid, sometimes there's nothing that I can say that's going to be as powerful to my kid as saying, I'm going to have dessert tonight, right? And there's a reality of that that I think it's like, okay to just name. So we're kind of along this topic and I want to transition to it, control. How do you see the relationship between disordered eating, eating disorders proper, control? What? Are there any signs that a kid way before eating stuff develops, might be prone to them given their relationship with control in general?

Speaker 3:
[14:24] A lot of people who struggle with eating disorders also struggle with anxiety. So they want to do things right. They want to do things perfectly. So that might be something you see early on. They see anxiety around perfectionism, anxiety, rigidity. We also see something, it's a fancy word for knowing when you need to pee, but this altered interoceptive awareness. So these are the kids who can play sports through an injury. They can stay up studying through the fatigue. They can ignore the calls and the social plans of their friends and just keep working on that project. That is an incredible skill. I think a lot of success comes from having this tunnel vision. And if you take that tunnel vision and direct it towards changing your body or changing the number on a scale, that's exactly what I think is so hard as a parent, is you're like, I want to praise that they stayed in the gym the extra hour. I want to praise that they stayed up late working on that project. And at what point are we praising behaviors that we don't want to see in ourselves as adults? We all talk about trying to figure out how to turn off, about how to know our own intrinsic worth. But what we're doing is praising behaviors that can lead to burnout, can lead to an eating disorder. I really caution people around exercise. When you see your kid exercising despite having an injury, exercising longer than their friends, especially in boys and men. So I just want to remind people that 40% of people with eating disorders are male. So this is affecting teen boys just as much as teen girls. But it's usually missed in boys because when a boy stays longer in the gym, it's praised. And then especially if you're at the gym, instead of going to a social activity, what's better for 15-year-olds' development than going and seeing friends in person, something we want all of our kids to do more of, not being in the gym?

Speaker 2:
[16:12] And look, and just for all the parents listening, right, I think, look, there's part of that that, of course, that moment students say, wow, you're working really hard, right? So I think, again, and I think we're similar, no rigidity there either as a parent. But it's just such a good moment as a parent to pause and say, okay, if I have a kid like that, and it's like, oh my goodness, Erin, are you talking about my kid? Is there just a nuance there I want to reflect on even if I don't change anything yet? Yeah, it's kind of amazing. My kid pushes past the type of signal or pain that would stop someone else in their tracks. That can be used as a superpower, but that also could flip on them too. And if I think about it in that nuanced way, maybe there are moments instead of just praising, I say, hold on a second.

Speaker 3:
[16:59] One of the things that's unique about eating disorders is we haven't really found a gene per se that's passed from parent to kids. But we know it's very heritable, like 86%, I want to say 85%, 86%. But what we have found is that it's a neurobiological-based illness. And so that the pathways in the brain that are in charge of things like interoceptive awareness, attention to detail, that is what's being passed on. So if your kid has these behaviors, there's really high chances you do too. Yeah. And it gives you an opportunity to say, like, I'm sure our children have seen both of us push through fatigue and get work done. And I'm proud of that. I'm glad that they've been able to see that. But how can I also make sure I'm saying to them, I'm burned out and I'm exhausted. Mom's been on too many planes. Mom stayed up too late too many nights in a row. I'm going to go hang out with my sisters. I'm going to skip work tomorrow and do something fun. And so it's modeling for them, figuring out when to use it as a superpower and when it's starting to hurt my quality of life.

Speaker 2:
[17:59] Can you help us understand, I know parents, they see a kid restricting, obsessing about food, binging, these things that logically, it feels like, why are you doing that? Like stop doing that. But there's something kids are getting from that or something it's doing.

Speaker 3:
[18:15] One of my favorite things and how I fell into eating disorders is because they really are about regulating emotions. And as someone who has very big emotions, I love just the honest talking about the ways in which eating disorder behaviors really serve people. They work until they don't work anymore. So what we see from a lot of the kids and teenagers that we work with is that they experience the same emotions as everyone else, but just at a louder volume. And if you are genetically predisposed to have an eating disorder, and you might find that when you're really stressed out, not eating actually makes you feel better. So for most people, if you don't eat, you may get hangry, you get grumpy. But for people who are prone to have an eating disorder, not eating actually relaxes you. I tell parents, I'm like, imagine you're going to go on stage and give a presentation to 100 people, 500 people, whatever is going to terrify you. And if someone offered you your favorite breakfast right before you went on stage, you'd be like, absolutely not. Your stomach would be in knots. You want to eat that afterwards. Well, that's what the stomach of someone with an eating disorder or who's prone to have an eating disorder often feels like. So not eating actually relaxes them, regulates their emotion. For kids who struggle with binge eating and purging behaviors, they also tend to also struggle with self-harm behaviors. When they feel that really big emotion, making themselves vomit numbs them out instantly. It just brings them from a 10 out of 10 to a zero. Now, usually shame comes after that and then they're back on the wheel of having really high emotions. But really reminding parents that these are serving a purpose and not to vilify them. Even in the eating disorder community, people are like, well, I have anorexia, that's the good eating disorder. Whereas, bulimia, making yourself vomit is the bad eating disorder. That is not true. And I tell parents, if you think your kid is vomiting, they are. By the time you think that they are, they are. Because eating disorders are so secretive. But don't freak out. Don't act as though that's the worst thing your kid could ever do. There are no worse eating disorder behaviors, and they're serving a purpose for them. So give them an opportunity to share with you when it's coming up, and let's help them to not give in on that urge.

Speaker 2:
[20:21] Yeah. And just as a metaphor there, like I think about how many of us, I don't know, we scroll on our phone at night, even though obviously we know that's not a good idea. Or we're saying we're going to go to the gym in the morning, but we snooze and we're like, well, I didn't do that, even though we know it would have made us feel better. And, you know, approaching that, someone came to us and was like, why are you on your phone? You know not to be on your phone. Why are you snoozing? Like, obviously go to the gym. I don't know anyone who's like, that is so helpful. I'm now going to change my behavior. Like, thank you. No. Right. And actually what helps us change the behavior, because also so many of us can be self-critical, right, is, okay, being on my phone at night must do something for me. What is that? Right. That's the start of, well, could I get that from somewhere else? Or what am I looking for? Snoozing in the morning, like, what's going on there? Beyond maybe being tired, is it, do I feel bad about my body when I go to the gym? And I kind of want to avoid that feeling. Like, we also regulate our emotions through maladaptive behaviors, right? And that is a practice to be curious. And I think what you're saying with restricting, binging, purging, on the surface, if we meet it with, why are you doing that? That doesn't make sense. We're actually not getting to the source. Like, what is this doing for my kid? Doesn't make you permissive. It actually makes you able to start figuring it out.

Speaker 3:
[21:34] And how can you help do that for them until they have the skills to do it?

Speaker 2:
[21:39] Say more.

Speaker 3:
[21:39] It goes back to kind of what you were saying about control. People think, I am going to get control of my thoughts by controlling my food. All I think about is my body. All I think about is food. You know what? I'm going to start controlling exactly what I eat, and that will make my thoughts go away. That is the lie of eating disorders, because it just makes it worse and worse and worse. And sooner, I had a mom call me once, and her child was 15, had just gotten back from residential. She's like, Erin, she is sobbing because she can't figure out if it's 15 blueberries or a third a cup of blueberries because apparently 16 fit in there and she doesn't know what she should eat. And that's an example of the eating disorder is actually in control. And so what parents do to help their child recover from an eating disorder is the parents take control of eating. You don't have to think about this anymore. I'm going to tell you what you're eating for breakfast, for lunch, for dinner. You don't have to like it. You do not have to compliment me. And you are even allowed to swear during it. I'm going to sit next to you and provide comfort while you do this hard thing. And you've been using restricting to help regulate your emotions. I'm going to help you regulate them in a different way until you have those skills.

Speaker 2:
[22:45] This is always my favorite metaphor. But you're actually showing me you can't be the pilot of your food plane anymore.

Speaker 3:
[22:52] I love that.

Speaker 2:
[22:52] Is that what it is?

Speaker 3:
[22:53] Yes. I absolutely love that.

Speaker 2:
[22:54] It's not because you're a bad person. And it's not because you won't be able to again. But I can see that. And so I'm stepping in because I love you. And I want to keep you safe. And I'm going to pilot this until you can take the reins again.

Speaker 3:
[23:07] I absolutely love that. And I'm going to use that because most parents call me and they say, I need to not be involved in their treatment because I will make it worse, because my team tells me they don't want me there, because this is about control. So I should give them the control to get through their eating disorder. And I remind them, your kiddo can't do this. Like, if your child was struggling with substance use, you wouldn't sit and wait for them to take the alcohol out of the house. You would go and get all the alcohol out of the house.

Speaker 2:
[23:33] I'm going to write that one down.

Speaker 3:
[23:33] Yes. And we talked to 50 different teenagers who started our family-based program, and zero of them wanted their parents involved, which is totally normal. And I said to their parents, like, you should be happy. That is a developmentally appropriate response. But when I asked the parents, why do you think your team doesn't want you involved? The parents are like, they think I'm going to make it worse. They think I don't know what I'm doing. They hate me. Oh, I get emotional here. When I asked the teens, why you don't want your parents involved? They say, I don't want them to know how bad it is, and I don't want them to worry. When parents know that, they're like, get out of the way, I'm coming in. At the end of the study, all of them except one were so glad their parents were involved. They also said, I wish they'd gotten involved earlier. It was incredible because every parent was thinking, am I making a mountain out of a molehill? Is this just a phase? Am I making it worse by getting worried or bringing them in to see you? And in the end, every kid said, I needed my parents sooner.

Speaker 2:
[24:34] You know, I think a lot about being long-term greedy as a parent, not maximizing or optimizing for immediate ease or happiness, right? But as a parent, like I'm thinking about who my kid's going to be five months from now, five years from now, 15 years from now. And I think with this type of treatment, it's short-term thinking, which we all have. They're going to be mad at me. OK, long-term greed would actually say, hold on, I want to maximize my kid's emotional health, physical health. I'm willing to put up with. Yeah, they might be short-term pissed. But like, I love my kid in this long-term way, and I want to set them up. And that can maybe help push past a little bit.

Speaker 3:
[25:11] Yes. Families talk about being stronger also when they get through treatment. And the parents also say, they're like, I am so much more emotionally regulated than I was before. It does take something special to tolerate your kids not liking you, especially when it's multiple days and weeks and months in a row sometimes, as eating disorder treatment can be, but I love that, the long-term greedy, the reward is there. You both get a healthy kid, but you also have a kid that is so grateful that you helped them get well. Yes.

Speaker 2:
[25:37] You know, when my kids were younger, one of the things I would say around our own screen time rules or bedtime rules, but it's kind of the same thing is like, my number one job is to keep you safe. And also it's to kind of make decisions that I believe are good for you long term, even if you're pissed at me in the moment. And I'm just going to say this, I love you enough to make those types of decisions. And this is one of those moments. And I kind of felt like a badass every time I was saying, like I had to like work myself up. But then I heard myself say it. And by the way, just to be clear, it wasn't like the kids were like, that was that was really an A plus mom. They then do the thing. They're like, you're annoying all my friends, whatever. But if you kind of set yourself up instead of in an apologetic way in this like bold way, I feel like I was then ready. I was like, okay, so I said my part, you're going to do your part, you're going to complain short term. Everything's going according to plan, and we're just going to keep walking down that path. I think one of the most memorable moments of my private practice, I can picture her in this moment exactly is this, and it's not eating disorder related, but I think there's such a parallel. She's 15 or 16, and she came up, she was cutting, that referred, and I asked her for a session, how long has this been happening? Two years. I was the first therapist she saw. And I said to her, okay, well, your parents, you told me, also have known, like how come you didn't see a therapist? Just curious, you know, me or anyone. She's like, oh, well, I told my parents, she was so snarky. I told my parents, oh, so you think I'm fucked up? I'm the messed up one in the family, and I'm just going to go and lie or not talk, and I'm going to waste all your money. And Erin, my heart always races, okay, because same thing, I think. She then just got silent, and her whole demeanor changed, and she looked up at me after a minute, and I just kind of for some reason, you just shut my mouth. She's like, can you believe they let me make that decision? It was from this snarky teen to this, I'm also crying, this really young, like, and can you believe they let me pilot the plane when I was showing in clear as day sign that I couldn't do it? And my rude words were enough for them to take their hands off the wheel? Like, and I always think about that because I think we take, I respect kids deeply, but we take their snark like way too seriously. And under it is so often such desperation and shame and fear. And by the way, I don't think it's seen like we're in our worst moments. We just want someone to kind of say, I'm not taking this at face value because I love the heck out of you. And you need a different level of help.

Speaker 3:
[28:26] My favorite to go to a hopeful story and why I'm just always like parents, be involved, be involved, be involved, be involved. Like, don't think that your absence is what your kid needs. It's your presence. There was a child who was trying to weight restore and she needed to have about 3,500 calories a day to weight restore, which is pretty normal. If you don't have an eating disorder, you only need a couple of extra hundred calories a day. But if you do, you become hyper metabolic and you need to eat a lot. And they could not figure out how to get enough calories on her. And so she had been the same weight for eight weeks. And the mom and dad was kind of scratching their heads. And one day the dad came into my office. He's like, I figured it out. He was so triumphant. And he realized we'd been talking about the neurobiology of eating disorders and how consequences are more salient than rewards when someone struggles with anorexia. And that's why we play through the pain. That's why we stay up studying because we got to get that A. And he's like, I figured it out. You know what's a big consequence is when she shows up late for school and everyone in first period turns and looks at her when she comes in. So I started making this high caloric shake. It was like an 800 calorie smoothie. And then he's like, I drove her to school every single day of the week. And he's like, I'd say to her, hey, listen, I don't have any meetings until 9.45 so I can stay in the car with you as long as it takes to finish your smoothie. I talked to the school counselor, you can walk into first period late, finish that smoothie in seven minutes every single day. Never got late to first period. But what was great about it is I didn't give them that idea because I don't know their child as well as they know their child. And so empowering parents to remember that they are this child's parent, they are the one that can help them get better.

Speaker 2:
[30:01] Go back to what you're saying about cancer. Like I don't know any parent is like, my kid doesn't want chemo. So but they're 16 and one day they're going to have to figure it out by themselves. And so I'm going to let them make this decision. I've never heard that.

Speaker 3:
[30:11] Never.

Speaker 2:
[30:12] Never.

Speaker 3:
[30:12] Never. Yes.

Speaker 2:
[30:13] We are kind of talking about and we think a lot about good inside about boundaries as part of our role. And I think the big difference and it's so many of us experienced this so differently that we have to reformulate it in our head is that these type of boundaries and assertion of what I think is parental authority without aggression is not something you do to your kid. It's something you do for your kid. And I think your whole model of eating disorder treatment is it's something you're doing for your kid.

Speaker 3:
[30:37] You do it for them and you do it with them and you go through it together. I talk with families when your kid is in crisis, whether it's depression or an eating disorder or self-harm, I might choose two things. Like I don't want to hear about their grades improving or they're not swearing in front of their little brother or right. And one of the first things that goes is no phones at the dinner table rule. And I'm like if they need to, I don't know, watch Gilmore Girls on their phone in order to distract themselves to eat the meal, then that's what they should do. And you're going to do it with them. You're going to figure it out. You're going to sit and watch the show with them, get engrossed in something.

Speaker 2:
[31:08] Yeah. Now, let me ask you, you know, we focus a lot on repair. At Good Inside, for the parent listening who's thinking, shoot, shoot, I've missed it. What do you want to say to them or where do they start?

Speaker 3:
[31:20] So first be so, so kind to yourself because you have been raised in this culture, this culture that, well, also, if you're a parent, you are after having dealt with the be smaller, you know, look different, meet America's ideals of beauty, you're now also hitting the don't age, don't age, don't age, something that there's nothing we can do about that.

Speaker 2:
[31:41] We can't live forever.

Speaker 3:
[31:42] We can't live forever. Yeah. So just be kind to yourself. And calling it out is the best thing that you can do for your whole family. And again, and again, and again, and again. You can say, oh, when I had that ice cream last night with you, I noticed my old thoughts of feeling bad about it come up. I mean, I'll give an example with actually when my son was nine, my oldest son was nine. This story just gets me still. He came home, and actually we were getting ready for bed. So he was like in his underwear. This is still the days when the underwear was colorful or had characters on it. They're so old now, the kids. But when he was nine, and he grabbed his belly and said, I want to get rid of this, I heard that cold showers would help. The first emotion I felt was anger. I'm like, how did this get in my house? He's a nine-year-old boy being raised by a parent who specializes in eating disorders. So I want all parents to know that even someone who's worked so hard for all foods fit, the kids see meat, all different foods, it's going to get there because the culture, the society, their peers, it is everywhere. So don't get too mad at yourself and you have this incredible ability to model that all foods fit, that you can change your behaviors, that just because you did something once doesn't mean you have to do it again.

Speaker 2:
[32:59] Yeah. Someone said to me, it's like a proverb, I can't remember who originally said it, but the best time to plant a tree is 20 years ago and the second best time is right now. The other thing I just want to give parents listening who feel like it's too late is, I feel like when we're in it's too late mode, we're doing the thing we all do. We look back and we think about all, I could have done that and that was a sign, and I didn't pay attention to that in the way I wish I did, and we all do that, and I don't think we could take that away, but what we don't add, I think, is this gaze forward, where we're like, okay, my kid is 13, my kid is 23, however old they are. There's actually so many more years ahead than behind, and that's not to convince myself out of my guilt, but just to add, okay, I'm actually a lot earlier today than I am 10 years from now than I am, and I think there's hope and a balance to that too.

Speaker 3:
[33:48] Yeah, my mom still wants me to be happy today, just like she did when I was 14. My mom still wants me to enjoy my life today, and so that'll be true too. And that story with Max, I had to tell my anger to move to the side for a second, but it was an opportunity for me to say to him, hey, did someone say something to you about your belly, or is it something that you say to yourself? And he's like, I say to myself, and I got to say, I'm like, you know, my brain says a lot of bad things about my body to me sometimes, too. He's like, really? I'm like, yeah. And then we talked about, like, how do we talk back to our brain when our brain's kind of a jerk? So it's the same skills we use for other things, but it was really an opportunity to remind our kids that this is a human condition. Yes. I think a lot of parents are tempted, as I am, to say, what? No, you're not fat. You're beautiful, and instantly correct their thought for them, which, as you said, doesn't work. But additionally, it then signals that there's a right and wrong. There are kids that come in all shapes and sizes, and might grow up to be an adult of all shapes and sizes. Yes. I remind my children that it would be nuts to be like, let's change your shoe size. No one's trying to change their shoe size. And they're like, this is a, wow, mom, what are you getting at? Right? They get very annoyed. But and yet we try to change everything else, our hair, our skin, our body shape, our weight. And just remind people the futility of it. So if you instantly tell your child, no, they are not fat and they are beautiful, you now told them that beautiful means not fat and they aren't that. Well, they've got, as you said, Becky, a lot of life left. And one of the only inevitable things is that we are going to age and our bodies are supposed to change weight as we age.

Speaker 2:
[35:34] You know, I'll never forget something my supervisor said to me once when I was in my postdoc and I was working on an eating disorders team. And we were talking about our own relationships, our bodies part of, you know, supervision. And she said, you know, it's interesting. I grew up and I was never a big fan of my body. But she's like, I grew up in a family where and we kind of talked about this idea of like your pie chart of self-worth. And if your body doesn't make up the hugest percentage of it, like, OK, I don't like my body right now, like, OK, moving on. And she said she got married. Her husband said to her, you might not be your own type. Oh, and it was like so beautiful to think about. Maybe we're not all at all points in our life going to say, I love my body. Maybe I don't love my shoe size. I don't know if I'm obsessed with my height. I'm 5'1 in a good day. I'd like a few more inches, you know. But as long as that or my relationship with my belly or my arms isn't like such a huge percentage of that pie chart, I can move about the world in a freer way.

Speaker 3:
[36:36] Oh, I really, really love that. The goal isn't for our children to always like their bodies. Our goal is for our children to navigate the world and find joy more of the time than not.

Speaker 2:
[36:47] When you said that, that gave me chills. The goal isn't right for our children to always like their bodies. The goal is for our children to try to like themselves amidst a whole range of challenging experiences and feelings they're going to have in a million different areas for the rest of their life. Can you talk a little bit about the importance of kind of National Eating Disorder Awareness Week? I think that's, I'd love you to highlight that.

Speaker 3:
[37:08] Yes, so a couple things. I mentioned that 40% of people who have eating disorders are male. And I say that as often as I can because men are being overlooked. Once we started treating patients of all ages, the number of 40 year old men who sought treatment, who had wanted to get care for decades, but didn't feel like there was any place safe to go. Thought that eating disorders were just a girl disorder. So I want to say that. So Eating Disorder Awareness Week helps remind people that everyone gets eating disorders. People of all ages, all shapes and sizes, all ethnicities, all races. I think another thing that's important is that if you are having any concerns, that means there probably is a problem. On a medical inpatient unit where I used to work, which is similar to all medical and patient units across the country, half of the kids who end up on a medical inpatient unit, they're there, one, because their heart rate drops below 45, because they have become malnourished, and they don't have an eating disorder diagnosis, and most have been sick for less than three or four months. So, I just want to remind people that eating disorders happen so fast, they thrive in secrecy. So, parents, if your gut is saying something's off, then you're right. I remind people that bad things don't happen for asking your kid. If you think your kid's vomiting, ask, are you vomiting? So many people will say to me, I think my kid is vomiting. And I say, what did they say when you asked them? They're like, I didn't ask them. What are the reasons you don't ask them? They'll make it more secret if I ask them, or maybe they're not doing it and they'll start doing it, or maybe they'll get mad at me. Most of the time when you ask your kid, they tell you the truth and they're so relieved someone asked. So, eating disorder awareness week is telling parents, trust your gut, trust your gut. No one knows your kid as well as you. And there's real reasons to act quickly. Eating disorders are the second deadliest mental illness. And since they happen so fast in kids, there's no such thing as getting treatment too early.

Speaker 2:
[39:05] You know, I think about this Mr. Rogers quote I've always loved when you say, ask if it's nameable, it's knowable.

Speaker 3:
[39:10] Love that.

Speaker 2:
[39:11] Your kid might say no, but you're also probably gonna get a parent sense in their response, right?

Speaker 3:
[39:18] And you also can ask things more than once. There's no, I mean, I think about how often I ask my other son, Sam, if he turned in his homework. I never thought like I'm only allowed to ask that once.

Speaker 2:
[39:27] Let's end with this. A parent is listening right now feeling, and I imagine there's a mix of more empowered, more knowledgeable, maybe also scared, ashamed, worried. What would you most want them to know?

Speaker 3:
[39:41] They hold the key to everything being okay. It is all within their control. They've got this. Bring in a village, use your village, talk to your kid, talk to your pediatrician, talk to an expert. There are outstanding treatments for eating disorders, outstanding medications. Your child will get through this just like they get through anything else, and they're going to get through it with you and probably because of you.

Speaker 1:
[40:09] What I keep thinking about after that conversation is how easy it is to miss the early signs. Not because we're not paying attention, but because so much of this can look normal at first. A skipped meal, a new interest in eating healthy, a comment about their body that hangs in the air a little longer than you expected. And of course, it will seem normal if this is the way we talk in our homes. If we as parents make comments about our own bodies or what we're eating, we're modeling what our kids think is normal. One of the biggest takeaways for me is this. We don't have to wait for something to become a problem to be mindful of it. We can get curious, we can stay connected, especially through puberty and adolescence when their bodies are growing and changing so much. If this is an area you're navigating in your family, we'll include additional resources in the show notes. Let's end by zooming way out.

Speaker 3:
[41:17] Deep breath.

Speaker 1:
[41:21] This InBetween Time feels like a lot because it is a lot. If you remember one thing, let it be this. They act like they don't need you, they still need you. I'll see you next week.