Eating disorders can be tricky because they affect both physical and mental health. On top of that, the symptoms aren’t always obvious. But diagnosing and treating them is really, really important. Getting a kid treatment is not only essential to their well-being, but sometimes even their survival.

On this episode of Mayo Clinic Kids, we talk with Dr. Jocelyn Lebow, a clinical psychologist and expert in childhood eating disorders, about diagnosing eating disorders and how to help kids heal their relationships with food, their bodies, and the people around them.

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Dr. Angela Mattke: I’m Dr. Angela Mattke, a pediatrician with Mayo Clinic in Rochester, Minnesota and I specialize in helping parents make sense of medical issues. On each episode of our podcast, we talk to different medical experts to help parents with kids of all ages answer the question, “What’s going on with my kid?”  On this episode: eating disorders. My friend and colleague Dr. Jocelyn Lebow was the one who got me interested in adolescent eating disorders.

Dr. Jocelyn Lebow: Eating disorders are not really well understood. Everyone has this picture in their head of what an eating disorder looks like, and it’s very specific. It’s a made-for-TV movie actress, it’s a white, cisgender, skeletal cheerleader, and that’s very much not the case.

Dr. Angela Mattke: What does a more typical eating disorder case look like?

Dr. Jocelyn Lebow: I’ll talk about a combo of a million cases, especially if you’re one of my former patients listening and you’re like, “That’s me!” No, this is such a common thing. This is not the exception. A patient, a 15-year-old girl who came in for depression, came in to see me because she’s been extremely depressed. She’s been sleeping all day. She’s low energy, she’s withdrawn, parents are concerned, everybody’s concerned—and she is absolutely depressed. She’s lost interest in things she usually likes to do.

She had had some trouble at school and stopped playing volleyball, so she would come right home and nap. It’s heartbreaking. I saw her a couple of times. We were starting to do some depression work, and then she casually mentioned, “Oh yeah, I tend to sleep through dinner.” And again, this is not uncommon. Well, it’s not uncommon for teenagers, but it’s definitely not uncommon for teenagers with depression.

They just don’t have energy to do anything. And I was like, “Well, that’s not good. And on a whim, I pulled her growth curve and I looked, and this 15-year-old girl who had been progressing beautifully, had dropped off her curve. She hadn’t gained weight for three years, which as a teenager is bad, super bad.

We know that when kids lose weight for whatever reason, past a certain point, it negatively impacts their mood. No matter how you lose weight. We talk about your brain sort of clicking over into this anorexic mindset. And so now, even though it did not come at all from shape or weight concerns, it and in no way if you had asked her, do you wanna be more thin? Do you think about your body? She would’ve said no. And it would’ve been true.

This still meets criteria for anorexia. And what’s more, and I think this is really important, you can’t effectively treat depression and anxiety. You cannot treat these things whether by medication or therapy, until you treat the malnutrition. And what then happens, and what has happened for this poor, sweet kid, is she’s coming to therapy, working as hard as she can. I’m making her do horrible things to try to make her mood better and it’s only working a little.

And what happened with her is she wound up feeling pretty hopeless. Feeling like nothing’s gonna work for her. When in reality it was like we were trying to treat something with the wrong medication. That’s not what she needed first. Even if it was something that predated the eating disorder.

Dr. Angela Mattke: Eating disorders can be tricky because they affect both physical and mental health. To treat them, we need professionals from both fields. That team needs to work closely with the family to make sure the kid gets all the love and support they need every day. And like Dr. Lebow just explained, identifying an eating disorder can be its own challenge. The symptoms aren’t always obvious. And they can get all mixed up with other physical or mental health issues.

But diagnosing and treating eating disorders is really, really important. When a growing body doesn’t get the food it needs, every system struggles — your stomach, your bones, your heart. And worse case scenario — eating disorders can be fatal. I wish that was a rare outcome, but it’s really not. 1 in every 5 people struggling with an eating disorder may die from complications from it.

Treatment is complicated. And it takes time. But the good news is, with the right care and support, a kid with an eating disorder can heal their relationship with food, with their bodies, and with the people around them. And as a parent, there is a lot you can do to help. Which is why I love talking to Dr. Jocelyn Lebow. She’s a clinical psychologist and expert in childhood eating disorders. She’s also a good friend and has helped me develop my own passion for this area. So Jocelyn, What is your background with eating disorders, and what pulled you into being so passionate and dedicating your career to this topic?

Dr. Jocelyn Lebow: I’m a clinical psychologist and I’m actually a generalist. I work with kids and adolescents up through young adults with sort of everything, depression, anxiety, friend issues like dating drama, but eating disorders has always been a passion of mine because I think, first of all, it’s way more common than we think. Way more kids have eating disorders than we realize, or disordered eating that we should be paying attention to. And it’s really fixable. Eating disorders when they’re left untreated, or when they’re undertreated, can be lifelong and really scary, but we can fix eating disorders, which as a psychologist, there’s not much I feel I can say that with such, like I can’t fix bad breakups very well.

I really got passionate about it through my clinical work and my research. The things that I study have always been an outgrowth of that, wanting to make it better, wanting to learn more.

Dr. Angela Mattke: Before we get too deep into the eating disorder stuff, what does healthy eating – for a kid – look like? What are the essential things that a body really needs to survive and truly thrive?

Dr. Jocelyn Lebow: Food, all the foods, every type of food. Also water and probably shelter, but I’m not gonna go into that. We crave what our body needs. And for kids especially, that’s a lot of fat, that’s a lot of things that they need to grow. It’s not probably the most complicated answer, but I would just say your body needs everything. Healthy eating is eating everything.

Dr. Angela Mattke: How do we define what exactly an eating disorder is?

Dr. Jocelyn Lebow: Psychologists have all these specific diagnoses that we use with all these criterias. But broadly, practically, I think you should be concerned about your child’s eating, if it’s interfering with their life. If they’re eating weird in any way and it’s making it hard for them to grow, to keep up with their friends, to enjoy things. If, as a family, you can’t go out to dinner if you’re having gigantic fights over meals, I think that is a reason to talk to somebody.

Dr. Angela Mattke: What are some of the most common types of eating disorders and how do they differ?

Dr. Jocelyn Lebow: We’ve got a couple of the OG eating disorders. Like the ones that everybody knows. Anorexia is the main one. And that is dietary restriction and either loss in weight relative to your curve. This is important. You can have anorexia at any weight. You do not have to be visibly emaciated to have anorexia, but you’re not eating enough and you’re either not gaining what you should, or you’ve dropped off your curve for another, you’ve lost weight and dropped off your curve. That’s anorexia.

You also start to do things to get in the way of gaining weight. Either you say, “I’m scared. I don’t wanna gain weight.” That’s sort of the classic. Or you say, “No, no, no, I’m fine to gain weight.” But then you don’t do it. You have smart kids, these brilliant teenagers, where I’ll tell them, “Okay, great, you don’t have anorexia. I believe you. You wanna gain weight. Go for it. Go home.” And if they don’t have anorexia, they’ll go home and eat a pan of brownies and drink 17 milkshakes and they’ll gain some weight. And kids with anorexia will be like, “Oh, no, no, no. I really wanna gain weight. It’s just I can’t. I’m never hungry at breakfast. And I decided that I was gonna train for a five K.” And I’m like, “Okay, these are decisions that are counter to the goal that we’re working on. That counts for anorexia too.

Bulimia is another classic one. This includes binge eating, which we define as eating more than a loss of control over your eating. Then doing something to purge is what we say. This could be making yourself throw up. It could be taking medication like a laxative, or diet pills or a Dh ADHD medication, or smoking cigarettes or vaping. Anything to kind of compensate for that.

Binge eating disorder is having the binge eating without the purging. The loss of control, eating without throwing up. It’s important to note this can also happen in every weight. Sometimes people think that this is only for kids in larger bodies, that’s not true, and then ARFID is another one. Where ARFID stands for Avoidant Restrictive Food Intake Disorder, these are often younger kids where they have dietary restrictions, but it’s truly not weight or shape-related. It’s sometimes related to being scared of an aversive consequence.

I’m scared something’s gonna go wrong. If I eat, my stomach’s gonna hurt. If I eat, I’m gonna get constipated. If I eat, I might choke. And it’s something that they’re trying to avoid and or extreme picky eating. I don’t like textures. I only eat these five foods and I’m super brand loyal and they have to be cooked a certain way to the point where they can’t gain weight. They’ve also fallen off their curve. They can’t keep up with kids. Their nutritional needs are not being met. 

And then we have started this miscellaneous category, other specified feeding and eating disorders. And it’s important to highlight, because this is the majority of cases, our diagnoses aren’t that great. Like the majority of kids we see fall into this category and it’s not less serious. If you look online for the symptoms of anorexia and your kid doesn’t quite meet it, if you’re concerned, you’re concerned.

The mortality rate is just as high, the risks are just as high. It basically just means our diagnoses aren’t there yet. We’re not capturing every kid very well. But this is anything that’s clinically significant that gets in the way of your kid’s life with regards to eating that counts. 

Dr. Angela Mattke: As both a doctor and a parent, it’s obviously super concerning to think about your kid being at risk. How prevalent are eating disorders among the adolescent and pediatric populations?

Dr. Jocelyn Lebow: Honestly, I don’t know that we have a great answer. Back in the day estimates used to be two to five percent. They used to be that these are pretty infrequent eating disorders. However, more studies are starting to emerge depending on how you define eating disorders. If you’re a little more loose with your diagnostic criteria. Some estimates have been twelve to fifteen percent and COVID has actually resulted in an exponential increase in eating disorders in adolescents and an increase in the severity.

We’re still getting all this data, we don’t know, but there’s some estimates that as much as a forty-three to eighty percent increase in eating disorder frequency since the pandemic. More than you think. You probably know someone with an eating disorder.

Dr. Angela Mattke: It’s sobering to think of it that way — how common they are. What are some things we can look for to know if our kid is struggling with an eating disorder?

Dr. Jocelyn Lebow: Eating disorders are secretive by nature. Even kids who are really great. Open book kids tend to be a little bit sneaky about this. That’s just what eating disorders do. I would look for if your kid doesn’t need new clothes, if your daughter had her period and suddenly doesn’t have it anymore, if your kid is just seeming more isolated, more withdrawn, again, that can mean a lot of things. But an eating disorder should be on the list. I think any increased body image distress. Like, I don’t want to eat that. I wanna be super healthy. It’s less common.

We get kids coming in saying, “Oh, I don’t wanna be fat.” It happens. But more often we get kids coming in saying, I’m just trying to be healthy. Health has almost become like a dog whistle for diet, culture and losing weight, but parents and providers are like high-fiving over their head like, “Yeah, we want you to be healthy.” That’s what we want, but if your kid is cutting out entire classes of food, like kids should be snacking, kids should be eating everything. If they’re not doing desserts anymore, if they are going with their friends to Starbucks and getting a small glass of water while everybody’s getting some giant whipped cream thing, I would be worried about this.

Dr. Angela Mattke: I would add one more. They get so busy and they’re not eating meals together with their parents, but all of a sudden there’s like so many excuses about, “I already ate,” or, “I’m not hungry. I’m gonna eat later. I ate at so-and-so’s house,” but you never actually see them eat. I think that happens so many times in the patients we see in our clinic.

Dr. Jocelyn Lebow: That’s such a good point. And I wanna be clear, I’m not shaming anyone for not cooking like magical Norman Rockwell-like dinners with like the giant Turkey. That’s not how we eat in my house. But once in a while, if you’re like, “Hey, we’re all gonna go out, or we’re all gonna get something to eat, or we’re all having pizza tonight, your kid should do that with you. If your kid is like, “Oh, I just ran out to do this. If you literally realize you have never seen them eat in the past month, I’d be concerned.

Dr. Angela Mattke: One of the most common questions we hear from families when their children are newly diagnosed with eating disorders is what caused it. What do we know about the causes of eating disorders?

Dr. Jocelyn Lebow: This is so hard because we know everything and nothing. Lots of stuff plays a role. Genetics plays a role. Trauma plays a role. All these things play a role, but nothing causes it in and of itself. In the type of work that I do, we don’t get super into causes of eating disorders and try to dig out the cause of eating disorders. Because one, it just gets really blamed towards the kid or towards the parent, but also it’s not really that useful.

The one thing I do want to emphasize though that I do think is important to think about, especially for kids in larger bodies, weight teasing, weight stigma, comments about their weight, even well-intended ones from healthcare providers, them needing to lose weight.

That is a risk factor. And the reason why, again, it doesn’t a hundred percent cause it, but I wanna emphasize it because I don’t think we think about it. Anyone with sort of a marginalized identity is at a greater risk. They have greater stress. I think in particular teens with gender dysphoria we know are overrepresented. In terms of our eating disorder patients. These kids are at a higher risk, both because of all of the distress and stress they have, and also because of their complicated relationship with their body, especially as they go through puberty. That’s a huge risk factor.

Dr. Angela Mattke: How does the scientific community define a healthy body, and how does that contrast to what we as an eating disorder community believe as a healthy body type?

Dr. Jocelyn Lebow: The people who are studying this in a way that is more rigorous have really taken a much more complex and nuanced view on what constitutes a healthy body. In general, what’s out there is a lot of talk about BMI. It stands for Body Mass Index. It’s this measurement that takes into account weight and height. Honestly, it was originally designed for a population measurement. It was never meant to be used how we used it for individuals.

But it’s this measurement that we use to track growth. But it doesn’t take anything into account. It doesn’t take into account how much muscle you have, it doesn’t take into account your genetics. There’s all these things about how Michael Phelps is in the overweight or obese weight range because of how lean, how much lean muscle he has. This idea that there’s a certain BMI that’s too high. If you have a BMI that’s higher than this, you’re bad. And if you have a BMI that’s lower than this, you’re good.

That frankly is not supported by the evidence. It’s harmful. I feel strongly that it’s very harmful. What we know, especially for kids, is everybody tracks on a curve that is unique to them. That’s determined by genetics.

Your pediatrician, ever since your kid was little, will always plot your child’s height and weight and BMI on a curve. You can see those dots all throughout time. And again, the issue shouldn’t be, “Oh, this is too high.” It should be “everything is, is everything in the line,” or is she kind of falling off in one way or the other.

It’s about trends. That’s how we use BMI effectively and you should track that way throughout your life. There’s studies that people in the overweight rate range, what we have classified as the overweight weight range, are actually the most healthy. These arbitrary classifications that we give to people that this is too high, this isn’t based on just population norms, they’re not evidence-based. And again, they could be really problematic.

Dr. Angela Mattke:  There are very specific long-term consequences for eating disorders, for physical, mental and emotional health, especially if they go untreated. Can you talk a little bit more about that?

Dr. Jocelyn Lebow: Eating disorders affect every single organ system in the body, and if they’re untreated or if they’re undertreated, if you get a little bit better, but not all the way back to restored eating normally, you can have long-term consequences with regards to bone health, with regards to your heart, with regards to your fertility menstruation, it affects everything, and at its most severe, when left untreated, eating disorders actually have the highest rate of mortality.

People die more from complications related to their eating disorder than almost any other mental health concern. Twenty percent of patients with an eating disorder will die from either heart issues or suicide related to their eating disorder. Awful, awful things. In terms of mental health issues. Higher rates of depression, higher rates of anxiety, and like I said, these symptoms just don’t respond to treatment very well. They’re much more persistent.

The other thing that we’ve known is, just a worse quality of life. Patients with a history of anorexia, especially if they’ve done some studies where kind of across the board, these are smart kids. These are kids who are capable of anything. But they tend to achieve way less academically.

They tend to have less job satisfaction. They’re not, it’s not dire. They’re able to hold a job. They just feel less joy or connection to what they do. Their relationship quality is significantly lower. The biggest risk, of course, is your child will die.

That’s the number one thing we need to be worried about. But the number two thing is that they’ll live and have a really small life, have a life that’s so much less than what it should be. And that, to me as a psychologist, is like a personal insult.

If you treat eating disorders, if you treat them to the completion, if you treat them using evidence-based treatment, they can get better. This is not something that your child has to have for their whole life. This truly isn’t.

Dr. Angela Mattke: Alright, we know what healthy eating looks like—eating all the things. And I mean all the things, and that includes desserts! We know what disordered eating can look like—eating weird in any way that keeps your child from enjoying being a kid, or prevents their bodies from developing properly. We know how to watch out for eating disorders; they’re secretive and sometimes hard to spot. Parents need to look for secondary signs, like your kid not needing new clothes or regularly making excuses like, “Oh, I already ate at a friend’s house.”

And we know eating disorders can be triggered by any number of things, and pop up in unexpected ways; like with the patient that Dr. Lebow mentioned who started with depression and then backed into an eating disorder. But, however it develops, once a kid has an eating disorder, the most important thing is to focus on diagnosis and treatment and not obsessing about what caused it. Jocelyn, how are children diagnosed with eating disorders?

Dr. Jocelyn Lebow: There’s a bunch of different ways your primary care provider can do it. Your pediatrician, your family, med doc, or a psychologist, a mental health professional. The thing I would say is eating disorders are sort of a specialized thing. The average provider doesn’t get a ton of training in this. And while they might catch it, they might not. If you’re sure that your child has an eating disorder and you go to your primary care provider or your generalist psychologist and they don’t catch it, getting a second opinion from someone who specializes is okay.

There’s a lot of resources online. Unfortunately because of the landscape, because of the way that things are for parents, and finding good care for eating disorders, there’s had to be a lot of parent advocacy work in this space. For example, feast which is a parent run, parent-led nonprofit. It’s this massive organization. They’ve got a website, where there’s all sorts of guides for how you talk to your provider, how you advocate, what are the things you should be asking for in terms of lab tests, in terms of referrals. That is out there for parents. Again, I wish you didn’t have to do all that legwork, but you’ve gotta be your child’s advocate in this sometimes.

Dr. Angela Mattke: And I can speak to it as a primary care pediatrician, but also an English center doctor. My training was very little. It was all after I completed all my training and my residency that I met you, Jocelyn, that I feel like I actually got training in it. And I feel like I know a lot more than the average pediatrician about eating disorders, and that doesn’t make other pediatricians bad, and it doesn’t make me good. It just means that our experiences are very, very different. And if you truly feel you have concerns about your child’s eating, growth, weight, shape, any of those things, and they’re not being heard or validated, you need to find somebody else that knows more about it and get them into treatment, and diagnosis as early as possible, because early diagnosis is critical.

Dr. Jocelyn Lebow: Same thing. Honestly, as a psychologist, I’m a clinical, I have a PhD in Psychology. I happened to have a rotation in eating disorders, but that was just because of where I was. Because of where I could find a spot. It’s not a standard. We go over it very, very quickly. Same thing in psychiatry training and there are things that, as a psychologist, it’s not standard for us to weigh our patients. But that’s a crucial part of this. We can’t evaluate medical stability. Psychiatrists, though their medical doctors are not used to doing that, you really need to make sure all these pieces are in place, and unfortunately, again, a lot of that burden falls on parents sometimes.

Dr. Angela Mattke: Parents are a key part of the team, but you’ve mentioned a couple other different types of medical professionals, mental health professionals who should be part of this eating disorder treatment team.

Dr. Jocelyn Lebow: Parents and caregivers should be right. If you are, if you have no idea what’s going on in your child’s eating disorder treatment, that is a problem. You should be part of it. You need a medical doctor of some sort. Whether it’s a doctor, whether it’s a nurse practitioner or a physician’s assistant, somebody who’s able to make sure your child is medically stable and safe. Then you need someone to provide eating disorder treatment.

That’s usually a mental health professional, usually a psychologist or a therapist or a counselor. Again, the big thing isn’t what degree they have, it’s what training they have. At higher levels of care you sometimes will also work with a dietician. Sometimes you will need a psychiatrist. But again, the main, crucial pieces of the puzzle that must be there is someone taking care of your child medically and someone making sure they’re addressing that eating disorder piece of it.

Dr. Angela Mattke: There are different levels of treatment for eating disorders. Can you outline and describe the different levels of treatments?

Dr. Jocelyn Lebow: In general, when you’re treating something, especially in a kid, you want to find the lowest level of treatment that will be effective. We wanna disrupt their lives as little as possible, to get them the help that they need because we want them being social and going to school and doing all these things again. That’s not always possible. Sometimes you have to change these things, but we want the lowest dose that will work.

For eating disorders, there are outpatient treatments. That’s sort of the lowest level of care. Groups are getting really creative with how to deliver this. Sometimes it’s via video or telehealth. But most standard is something like family-based treatment or for bulimia, for binge eating disorder, there’s some individual treatments where your child, and ideally, most likely you, as a parent will meet with a provider once a week, and then probably a medical provider to maintain medical stability. If your kid is not medically stable, they’re gonna have to go to the hospital to get medically stable. And that’s sort of different from these things, and Angie, maybe you should talk about what that looks like or what that is.

Dr. Angela Mattke: Medical stability means that their vital signs are not in a very concerning zone. Really low heart rates, or they can have problems with their heart rhythm that can predispose them to develop really life-threatening arrhythmias. They can have problems with their laboratory findings, specifically their electrolytes, which can be really, really concerning if their electrolytes are abnormal, that can predispose them to go into cardiac arrhythmias, which can be life-threatening.

If there’s any concern with their electrolytes, any of their lab findings or any of their heart rate, blood pressure, glucose, or temperature findings, that’s how we define medical stability. And in some situations, those can be more concerning than others. We do have to admit the patient to the hospital to get them the proper treatment so that their level of acuity and risk for really consequential and severe things happening comes down. And then we can resume kind of more eating disorder treatment.

Dr. Jocelyn Lebow: In general, depending on how sick your child is, depending on the diagnosis, this can be six months to a year. So it’s long, but it’s necessary. If that’s not sufficient, if your kid’s symptoms are really severe, if you’re not able to get things moving right away. Again, that’s not a commentary on you as a parent. That’s not a commentary on your kid. Some kids need more. We need higher doses, and so then there’s day treatment where some kids will go for half the day, a couple of days a week. Some will go all day and come home and spend the night with you and spend weekends with you.

Higher level than that is residential, where kids will go and stay for a couple of weeks to a couple of months depending on how sick they are. And again, for each subsequently higher level of care, usually you step down. If you go to residential treatment, you’ll usually be there for, again I’m generalizing, but a couple weeks or a month, you step down to the day program for a little bit. Then you step down to be an outpatient. So it’s long, it’s a long treatment course, but again, you have to treat eating disorders fully.

Dr. Angela Mattke: Let’s revisit your patient again. What happened with your patient as they entered treatment and went through the process? Because it’s such a long journey.

Dr. Jocelyn Lebow: Well, she got really mad at me. Basically once I figured this out her parent had been appropriately involved in coming in for the last 10 minutes of our sessions when I thought she had depression, to kind of talk about where she was at and how to support her. But this kind of changed the game. I had to call them in and say this is what I’m seeing. I’m concerned. This is my diagnosis. This is why we’ve been seeing so many mood complaints and we had to shift. I started doing family-based treatment with them. I started putting parents in charge, really focusing on eating and weight gain.

The teenager hated this, hated everything about it, hated my face, hated coming in. But it was necessary. And we had to shift very much from how the teenager felt. How does she think about helping her make these right decisions and set her goals? We had to shift to “you’re here for every session.” We want you here for every session, but you do not have a choice because this is life-saving treatment. And, talking with parents about weight and eating, it got very focused for a while on the number on the scale and getting her to eat appropriately for her body which it’s sometimes a surprise for families.

They’re like, “You’re a therapist. Why are we talking only about food? But again, it was because this is what was necessary to save her life. All of it was really difficult. It was hard for the family, but it probably took about five to six months to get things reversed. And we would meet every single week. The parents were part of the full session. We’d weigh the patient every single week and keep tracking it. And as she started to get closer to her, back on her curve, we started to restart some of the mood stuff that we had been doing before. I mean these parents were heroes. They were able to pivot, they were able to do this incredibly difficult work in the face of their child’s resistance. I truly believe they saved their daughter’s life. I really do.

Dr. Angela Mattke: What happened to her mood, as you focused on her weight recovery?

Dr. Jocelyn Lebow: In the beginning, it got worse because she was mad. She didn’t want to do this. The eating disorders changed. They literally changed the structures in kids’ brains, and eating felt awful to her. She felt fat, she felt uncomfortable, she felt full. She didn’t wanna do this. She had already been depressed. For a little bit, it gets worse. It looks worse. She even had thoughts of, “I wish I was dead. I don’t wanna do this.” Which were really, really concerning. Understandable for everybody. But as she started to gain weight, as she started to get closer to that weight goal, we started to see things bounce back a little.

She started to suddenly have more energy. She started to be less fatigued. She started to have more interest in things she used to do. Parents would say things like, “It feels like my kid is coming back,” for moments, and then she’d disappear or scream at them because they wanted her to have another snack. But, she started to laugh at and make jokes and be creative and all those things that had kind of been robbed from her that we really thought was the depression, but I think was the malnutrition now.

Again, by the end, she still had a little bit of work to do on her mood, but it was nowhere near. She had no absolutely no thoughts of wishing she was dead. She had so much motivation to engage in treatment and she was able to make a really quick recovery with the rest of the stuff she had to do.

Dr. Angela Mattke: What can our communities start to do to really start to combat eating disorders and some of these societal norms that we’ve created in ideals?

Dr. Jocelyn Lebow: You know, this is hard. We’re so steeped in weight stigma in our culture. It’s in the air we breathe. Every single thing has these messages about the right body, the wrong body, the right food, the wrong food.

The more we can start to become aware of that, and again, it’s not an individual level problem, it’s a societal problem. But the more we can be aware of these messages that are getting sent to our kids, and the more we can actively combat them by being annoying, by calling them out, by challenging these ways of thinking, I think that helps everybody, including ourselves.

But  that’s very difficult to do. Especially as parents, we’re also worried we’re gonna do the wrong thing for our kid, so I think it’s being kinder to ourselves and recognizing how these biases maybe are playing a role in our own parenting. because again, they’re playing a role in every single person’s parenting.

I don’t know, joining the revolution, trying to take steps to move away from that.

Dr. Angela Mattke: It truly is. It’s starting with yourself and looking and combating what you do, what you eat, what you say, and how you value other people. It is rooted in some of these stereotypes we have about bodies and shape. Thank you Jocelyn, for coming to talk about such an important topic, especially near and dear to our hearts, 

Dr. Jocelyn Lebow: Yeah. Anytime. Thanks for having me.

Dr. Angela Mattke: Diagnosing and treating eating disorders can be really complicated. But the end goal isn’t that kids need food. Food is medicine. And that’s pretty much it. If they’re being weird about eating, see a doctor. And if that doctor’s not concerned, but you still are, see a specialist or get a second opinion.

You’re the one who’s with that kid every day, so trust your instincts, advocate for them, and don’t be afraid to err on the side of caution. An eating disorder is a life or death issue. And they’re unfortunately very common. If you’re feeling overwhelmed, feast-ed.org is a great place to start. There’s support for you, too. Check your local hospital or clinic for support groups, and consider seeing a therapist yourself. Treatment can get really intense for everyone involved. Remember, don’t stress out about rooting out causes. The best thing you can do is love your kid, love yourself, and, most importantly, eat food.

That’s the deal with adolescent eating disorders. But if your kid has something else going on. And if you’re over there wondering “What’s up with my kid?” send us an email at [email protected], and we’ll see if we can help you out.

Please remember, this podcast cannot provide individual medical advice and the discussion presented here cannot replace a 1-on-1 consultation with a medical professional. But you could always ask your doctor to try talking at 1.5 speed in real life and see how that goes. Thanks for listening!