Melanie Cole (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy.

I'm Melanie Cole, and I invite you to listen as we discuss disordered eating in our children. Joining me is Dr. Katelyn Anderson. She's a pediatric psychologist at Children's Health of Orange County. Dr. Anderson, it's a pleasure to have you with us. This is a really great topic and something that not a lot of parents-- I mean, we heard about it for a while, kind of went up and down in the media, but not a lot of parents really know what it is. So first of all, tell us a little bit about yourself and your expertise in disordered eating in our children.

Dr Katelyn Anderson: Absolutely. Thanks, Melanie. I'm really happy to be here today, speaking with you all. As you mentioned in your introduction, I'm a pediatric psychologist here at CHOC. I actually worked down at CHOC at Mission, which is one of our satellite locations in Mission VA Health. And here, we have our eating disorder medical stabilization program. So I'm one of the lead psychologists working here with youth, adolescents who need to actually come into our medical hospital for treatment of severe malnutrition due to disordered eating. So I've been in this role for about three years now. And then, I also have the opportunity to work at one of our outpatient eating disorder clinics up at our main campus at Orange, supporting youth and families, trying to intervene early when we noticed signs of disordered eating and help them get connected to the support that they really need.

Melanie Cole (Host): So how common are they, Dr. Anderson? Are they more common in girls or are boys susceptible to them too? Tell us a little bit about that?

Dr Katelyn Anderson: Yes. Unfortunately, eating disorders affect, gosh, more than, I think, 30 million Americans and many more youth worldwide. Among females, we know in their teens and 20s, the prevalence of even kind of clinical and then subclinical eating disorders could even be as high as 15%. So they're very common and I think often seen as more of a challenge among teenage girls, but we know that boys are actually just as susceptible to disordered eating and body image concerns as girls. And we're seeing the rates of eating disorders in our young males rising.

Melanie Cole (Host): Well, I'm glad you brought up body image disorders because that can go across the spectrum. And right now, in these COVID times, you're seeing more of these, right? And even somebody who is considered obese could suffer from an eating disorder and malnutrition, correct?

Dr Katelyn Anderson: Absolutely. I think that's another really important misconception that we need to start correcting in our culture, is that eating disorders come in all shapes and sizes, and that extreme weight loss or even weight gain, regardless of someone's body composition can be very concerning and really damaging for someone's mental and physical health.

Melanie Cole (Host): Well, it's certainly true. Now, we hear these terms bandied about anorexia nervosa, bulemia. Can you tell us what those really are? Can you be diagnosed with both? Do they go together? Tell us what those are.

Dr Katelyn Anderson: So anorexia nervosa is probably the eating disorder that most comes to mind when people think about disordered eating in our culture. So that really is an eating disorder that's characterized by extreme fixation on body image and an attempt to try to lose weight or change one's body shape by really restricting the amount of calories or nutrition someone is taking in. So they may also begin to exercise or engage in other behaviors to try to lose weight. And one of those in that context can be making oneself vomit or getting rid of food in some way, even by using laxatives. So that idea of kind of purging, we call it, can absolutely co-exist with anorexia nervosa.

The difference in someone who is diagnosed with bulemia nervosa is that there's not necessarily that same level of restriction, but instead with bulemia, someone is engaging in eating, what would be considered a very large amount of food in a short amount of time and they're often kind of feeling out of control and eating past to point of fullness that's comfortable and then engaging in kind of those behaviors I described to try to get rid of that food in some way, whether it's by throwing up or abusing laxatives or diet pills. I hopefully kind of explained those two different diagnoses okay. But they, with the same symptoms, can absolutely occur at the same time, but the diagnoses wouldn't necessarily occur together, if that makes sense.

Melanie Cole (Host): You've cleared that up very, very nicely for us. Now, as far as signs and symptoms for parents, for loved ones, what is it we're looking for in our children? Because again, with a mental health epidemic that's going on in the country today, parents are really hypervigilant looking for these red flags and this is a really dangerous one. Can you tell us what we're supposed to be looking for?

Dr Katelyn Anderson: Absolutely. I would really encourage parents to take note, first and foremost, of kind of a deviation or a change from your child's or adolescent's normal behavior. So they're noticing perhaps that more so than previously their child is just refusing to eat certain foods, maybe they're becoming more talkative about calories or about their body image. We of course want to really pay attention to fluctuations in weight, so that could be going up or down. Any secretive behaviors around food, hiding food, eating more after everyone else has gone to bed, expressing intense fears of gaining weight, is definitely something to pay attention to. And then, like you mentioned, so much of eating disorders, it really is a mental health condition. And so, we do want to pay attention also to, again, changes in mood, more irritability, more anxiety. Sometimes kids may have a scary experience with food, like they have a choking incident or they get really sick. And so, we want to pay attention also to kids who might then become afraid of eating after some kind of scary experience with food.

Melanie Cole (Host): So, what are we to do if we spot some of these signs and we keep note, we bring it to our medical home, yes, our pediatric provider first? But while we're doing that, because sometimes it can be pretty devastating and emergent. But when we're doing that, what can parents do in the meantime? I mean, we're not supposed to try and push food on them, right?

Dr Katelyn Anderson: Yeah, that's right. What I encourage parents to do is really try to be as open and honest as you can about your concerns and then stick to the facts, stick to the things that you're noticing, what have you observed. For example, maybe saying something like, "Hey, I've noticed you seem more down lately and you've stopped eating dinner with us." Showing that compassion to your child, showing that you're concerned, but also making sure that you're firm in kind of the need to get that help, right? I think that's both that are really important, showing compassion that you're concerned, but then also stating, "I'm worried enough that I do want us to go to the doctor and talk about this."

I think other things parents in general can be aware of, especially if they're noticing some of these changes in eating or body image concerns, avoid commenting on your teen's weight or size or even the size of others. Sometimes when we focus so much on body image or weight and shape, it can kind of send the message that that is the most important thing about someone. So try to practice just expressing appreciation of qualities in kids and others outside of appearance. And then, encourage a lot of enjoyment of all types of food in the home. I think avoid labeling foods as good or bad, and really encourage kind of balanced eating. So I think those are some general supportive tips that parents can use as they're of course seeking the professional help that we know is really almost always required to support someone who's really struggling with an eating disorder.

Melanie Cole (Host): Well, I'm so glad you brought that up about parents and the way that we look at body image and women, especially we're so mean to ourselves. We say things to ourselves. We wouldn't say to anyone, and we certainly shouldn't be saying them around our kids, right? It's so important. I'm an exercise physiologist, Dr. Anderson, and we've learned over these years that when we women look in the mirror and say, "Ugh, God, I'm so fat" or "What happened to my thighs?", that we are then transferring that if our daughters and our sons are hearing us say that, that's going to automatically-- So role modeling those healthy behaviors is so important for the whole family, yes?

Dr Katelyn Anderson: Yes, absolutely. I think parents are often really overwhelmed with how do I possibly protect my child from all of the messages that are so prevalent in our culture about prioritizing thinness above all else or lean muscles. And what I say to parents is start within the little circle of control that you have within your family, within your small community. Start making those changes with your family members and close friends and go from there. So think about how you can set that example because parents are such powerful role models and support figures for their kids and teens. So encouraging parents to set the example themselves is where I like to help them start. And so much of that just comes from how we talk about food, how we talk about our own bodies. We really want all kids to understand body diversity and then food freedom, right? We say here, "All foods fit." So helping kids to have a healthy relationship with foods means having a healthy balance of takeout, fast food, salads, farm to table. We kind of say that all can be part of a healthy diet here. There's no good or bad.

Melanie Cole (Host): I love that you said that, because there really isn't and we have to really celebrate how we look and accept who we are and who our loved ones are that way and not put so much emphasis on-- And I know the media has had a big role to play in that. And before we wrap up, where can we go to get support? We've already discussed that we go to our pediatricians first, but tell us a little bit when it becomes a really emergent condition. Why is it important for children's and teens with disordered eating to visit a child or teen-specific clinic that really knows how to work with these kids?

Dr Katelyn Anderson: Yes. As you mentioned, it's so important to really seek that medical help because, unfortunately, eating disorders are so serious and life-threatening because of the impact that they have on our physical health. So getting that evaluation by a pediatrician or even at your emergency department, if you're very concerned imminently, is going to be really, really important.

There are some wonderful resources for both teens who may be struggling and their parents I love. It's called NEDA, N-E-D-A, or the National Eating Disorders helpline, which has a text line for youth and it's also a phone line that's available 24/7 for parents. So, kids or teens or their parents can just text NEDA, N-E-D-A, to 741741 to get immediate support.

Melanie Cole (Host): And now, I'd like your best advice. What would you like parents to do? And we've reiterated and you're kind of reiterating and wrapping this up for us with a summary of what we can do as role models to help our children to see food as the positive bone-building, strengthening nourishment that it is for our kids and ways that we can really recognize if something is truly wrong and our children are suffering from disordered eating.

Dr Katelyn Anderson: Absolutely. Parents are such important role models and key players in their child's health and emotional wellbeing. And they can set an example by encouraging positive self-talk both in themselves and in their children modeling acceptance of all sizes and also allowing all types of foods into their home, encouraging enjoyment and balanced eating of a variety of foods.

Parents know their kids best, we always say. As parents, you are the expert in your children. Pay attention to any big changes in their eating and in their mood, pay attention to what they're saying. And if you're noticing some really big deviations from what would be normal for them, say something with compassion, but also a firm need to act. Encourage your child to speak openly with you about what they might be experiencing and then bring your concerns to your pediatrician or mental health provider. It's so important to seek early intervention and early detection is so key in a better prognosis for children and teens struggling with disordered eating. So the sooner that you can bring them to get some of that support, the more likely we can be to help a child who may be struggling with some disordered eating, not develop or progress into having a full blown eating disorder.

Melanie Cole (Host): Thank you so much, Dr. Anderson, for joining us. What great information. Such an important podcast for parents to hear. Thank you again. And for more pediatric health and wellness tips, please visit choc.org/mentalhealth for more information and to get connected with one of our providers. Thanks so much for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children's Health of Orange County. Together, we can keep kids happy and healthy. And please parents, remember to share these shows on your social channels as we're all learning from the experts at the Children's Health of Orange County together. I'm Melanie Cole.