0:00

Just a quick warning for our listeners' fate.

0:02

We're going to be talking about some touchy

0:04

subjects including disordered eating and eating disorders. First

0:08

of all, Etti I want to welcome some

0:10

new listeners. A podcast! Yes! January is

0:13

always a great time. Lot of

0:15

people coming to the show apple

0:17

featured on me and also over

0:20

on our membership. We went thirty

0:22

one days helping people to change

0:24

their attitude about exercise. It was a

0:26

lot. It was etti in your everyday for thirty one days are

0:28

know how people made. It through what they mean group.

0:30

So if you're listening to us and you say

0:32

like oh my god I don't want any ads

0:34

Well we did actually write a book. Yes

0:37

for all the new listeners that are just joining us

0:39

at in I wrote a book all about this stuff

0:41

and we we the audiobooks. We just want to shout

0:43

that out for the people that are now. And

0:46

guess what? The name of the

0:48

book is? What's the name? Food.

0:50

We need to talk. Whoa. Whoa.

0:52

Etti how we cope with that And so

0:54

original. Anyways,

0:56

Guys, I want to check in on Eddie's

0:58

year's resolutions because it's the end of Jj or

1:00

is already done. It's February. What? Is

1:03

going on with the news resolute? Are you joe

1:05

yet? So my first New Year's resolution which I

1:07

am sticking by is not to make any resolution's.

1:09

Oh. So

1:12

if fair, no no no no it

1:14

got worse than that because then I

1:16

made a resolutions I broke. The first

1:18

are my they are ah oh my

1:21

goodness so I'm just damned. But I

1:23

am moving into more said of strength

1:25

training. Yeah, Oh yeah,

1:27

and. I've come to understand that

1:29

just lifting hand weights is not going

1:31

to be sufficient for were or oh

1:33

my gosh. So

1:36

so how goes wild with Ah So

1:38

we buy Wife and I are moving

1:40

more towards let's get someone to show

1:42

us what we really need to do

1:44

to see what our bodies are made.

1:46

Which a when you getting them. Were. Gonna contract?

1:48

You know have a a personal trainer

1:51

when when it's it's the the next

1:53

step of of planning is happening and

1:55

I will keep your name. Look. A

1:57

big picture is the final A He's He's. Putting

2:00

off telling us what I'm saying and

2:02

saying okay well I have to report

2:04

that minute or solutions. Have a

2:07

not been even written down or thought of

2:09

and if among have no chance of being

2:11

done because I got a new dog. You.

2:14

Guys, I have no less. all I do as he

2:16

has a dog she's four months old. But I do

2:18

have to say like I haven't even had time to

2:21

think about whether or not I can. Make.

2:23

A resolution to do anything. Ceo is.

2:26

What? If the resolution were to get a dog,

2:28

On A.gov Ray idea as of art

2:30

is a huge I has made her

2:32

resolution and reach. Says I already

2:34

did. Gradually south think

2:37

he's on. The dog's name is. The

2:39

does name is Pooh Bear P

2:41

O O H okay everybody agrees

2:43

Lake and he is a city

2:45

pomeranian ice sheets who. Put.

2:47

On them Iranians? are you that

2:49

it over? And he's a sweetie

2:51

pie and Pooh Bear is a

2:54

Cd and he's a sweetie anyways.

2:56

Ah, onto the more. Ah

2:58

heavy a topic today ago have have

3:00

that I'm a cute dog to a

3:03

new eating disorder exactly That show us

3:05

okay. Because National Eating Disorder Awareness Week

3:07

is coming up at the end of February,

3:09

we want to dedicate some time to If

3:12

he says as you guys know, it's

3:14

a very important topic to both Etti and

3:16

I in the books as to entire chapters

3:18

dedicate his orders only a thing like that

3:20

as exercise know that shooting we are

3:22

the most about or Easterners and exercise. And

3:25

we covered this actually way back when

3:27

we first got together. So that was

3:29

on Twenty Twenty. Yeah, so some four

3:31

years ago. so we thought maybe it's

3:33

time for an update. right? So in

3:36

today's episode we're going to be talking

3:38

about all things eating disorders. What are

3:40

the most common eating disorders? We go

3:42

over one. I haven't heard much about

3:44

our city and we've and has a

3:46

little bit up Orthorexia and what that

3:48

is. And then the very tricky topic

3:50

of what to do with someone close

3:52

to is exhibiting symptoms of eating disorders

3:54

and you don't know how to talk

3:56

about it. I

3:59

and you know john. I'm Dr. Eddie

4:01

Phillips, Associate Professor at Harvard Medical School.

4:04

And you're listening to Food We Need to

4:06

Talk, the only podcast that can go from

4:08

cute dogs to eats. I'm like this

4:10

kind of stupid. Welcome

4:22

to another episode. Today we are joined

4:24

by Avelina Cambenas, who is a Clinical

4:26

Research Fellow at the Eating Disorder Clinical

4:29

Research Center at Massachusetts General Hospital. Did

4:31

I say all that correctly? Wow, that

4:33

was good. A clinical and research program. Oh,

4:35

you guys. I was so sad. Same old,

4:37

same old. Okay, cool. Well, thank

4:39

you so much for joining us, Avelina. This is

4:42

a topic that's really important to both Eddie and

4:44

I, and obviously to you as well. Thanks

4:47

for having me. So first, can we

4:49

kind of cover the basics about what

4:51

the most common eating disorders are, and

4:53

at what rates they affect the population?

4:55

Yes, for sure. So we'll kind

4:57

of start with what we think of as like the core

4:59

three. Of course, those are

5:02

anorexia nervosa, bulimia nervosa, binge eating disorder,

5:04

and then there's also a wooden restrictive

5:06

food intake disorder, which is new as

5:08

of the DSM-5 in 2013, and I'll

5:11

talk a little bit about that as well. So

5:14

starting with the most common, that would

5:16

be binge eating disorder. And

5:18

we see prevalence at about like one-ish,

5:21

just up to 3.5% in females, and then up

5:23

to about

5:25

2% in males. So

5:27

that's the most common one. Could I just ask you

5:29

a question? Yeah, for sure. With binge eating disorder, or

5:32

I guess with all the eating disorders we'll see soon,

5:34

it seems like the rate

5:36

is higher in females than men. Do

5:38

we know if that's like a thing that

5:40

men report it less, or is it actually the

5:42

effect men less than the effect women? Sorry, not

5:44

the derailleur. No, you're totally okay.

5:46

That's a really good question. I don't

5:48

know that we have the answer necessarily to

5:51

that question. I definitely think that men are

5:53

underrepresented in eating disorders research due

5:55

to lack of awareness, maybe stigma, maybe

5:57

fewer men reporting, so I'm

5:59

not entirely... Sure if it's and he

6:01

don't give you the summers that's what

6:03

we know, the song, the research but

6:05

it could certainly be higher on in

6:07

males and when I'm reporting about answers

6:10

your question of it side in Turkey

6:12

he put me under to live i

6:14

believe me nervosa and at about up

6:16

to one point five percent in females

6:18

and point one percent and males and

6:20

then for interrupting her but at that

6:22

point nine percent and females point three

6:24

percent in males answer when it was

6:26

resuscitated. disorder are said because it's more

6:29

knew we'd shudder. Only. Know less about

6:31

it, but it would probably be

6:33

abolished. Jewish. Percents across genders and

6:35

you just go over the last category.

6:37

Slow it down. There were me a

6:40

little best. We've got a few questions asking about

6:42

or fit and I'd actually never know what it is.

6:44

I. Can talk day and night.

6:46

Bar said I still have to

6:48

answer any questions. My hops so

6:51

are said avoided restrictive food intake

6:53

disorder was introduced as as feeding

6:55

an eating disorder in the Dsm.

6:57

Five So and and Twenty Thirteen

7:00

is characterized by wouldn't are restricted

7:02

eating that causes all sorts. Of

7:04

difficulties and things like weight

7:06

loss, failure to gain the

7:08

vitamin. Deficiencies, nutrient deficiencies, dependence on supplemental

7:10

feeding Rolling says general psychosocial pyramid and

7:13

the kind of big thing with are

7:15

fitted in contrast to other feeding and

7:17

eating disorders or other eating. That's where

7:19

they should say it's not and to

7:21

risen by any kind of sheep in

7:23

week. Concerns so small with our said

7:26

generally don't really have an many concerns

7:28

about their body or the like their

7:30

bodies. They don't want to lose weight

7:32

but rather what we see our if

7:34

it has been motivated by his arms

7:37

three profiles is what. Be. Which

7:41

is to sue. The Two Buddies

7:43

to the Seas reprise of To

7:45

Be Sure Peace Smell. The

7:47

second one of the reverse the consequences of

7:50

eating and this refers to things like choking

7:52

or vomiting and person has had a really

7:54

kind of a traumatic event happened to them

7:56

and they begin to restrict their feet and

7:58

take following. Not too. And

8:01

then the third is lack of interest or food

8:03

is eating. And what that means is that

8:05

someone just has like premature fullness

8:07

or doesn't really feel hungry all

8:09

that often, doesn't particularly like or

8:11

care or enjoy food. So

8:14

I spent a good part

8:16

of my career taking care of older

8:18

adults and in some circumstances, especially late

8:21

in life, we've got older adults

8:23

that sort of start like losing interest in

8:25

food or they actually lose their appetite. Does

8:28

that fit under this category now? Yeah,

8:30

it'd be hard to say. It

8:33

can't be due to another medical condition. So I think we'd have

8:35

to kind of take it with a grain of salt for whether

8:37

or not we could apply ARFID in that situation. I

8:39

don't know if there's like a cut and dry

8:41

yes or no answer. It kind of would

8:43

depend on the patient's presentation and what

8:45

other consequences they're experiencing and

8:47

what else is going on for them. And

8:49

also like whether or not this is just something

8:52

normative observed in the population with older

8:54

age. And just

8:56

to review the DSM-5 that you

8:59

mentioned is, let me get it

9:01

straight, the Diagnostic and Statistical Manual

9:03

of Psychiatric Illness. So

9:05

mental disorders. So

9:07

I can answer my own question. In

9:10

that case, it's not like a hormonal

9:12

thing or lack of taste or

9:14

something where they lose this is something more of categories

9:17

as a mental disorder. It is.

9:19

It could certainly be associated with

9:21

hormonal abnormalities or something like that, but

9:23

it is recognized as a mental disorder

9:26

or psychiatric illness. So zooming

9:28

out a bit, so I know we talked a bit

9:31

about each eating disorder. Can we

9:33

talk about why anorexia I think is the

9:35

most known in the media or the most,

9:37

I don't even want to say glamorized as

9:39

a word for eating disorders, but I do think anorexia is a

9:41

bit glamorized or at least it used to be, even

9:43

though binge eating disorder is the

9:45

most prevalent in the population. Why

9:48

do we never talk about binge eating disorder and why do

9:50

we see or picture an

9:52

eating disorder as anorexia? Yeah,

9:54

That's a really good question. So I

9:56

Think first and foremost, anorexia is often

9:58

highlighted in media. In popular culture

10:01

perhaps more so than binge

10:03

eating disorder, believe you, nervosa

10:05

and a think that in

10:07

part leads to increased awareness

10:09

recognition. The second component of

10:11

that is that the visible

10:14

symptoms of inox. Yeah, so

10:16

typically. Typically on

10:18

sleep in order to meet criteria for anorexia

10:20

your B M I have to be underway

10:22

and as very much something that you can

10:25

see. Lead you can season which

10:27

injury and thirteenth of visible symptoms

10:29

that are associated with the third

10:31

new says me. Make it more

10:34

noticeable enough more commonly thought of

10:36

as an eating disorder. That being

10:38

said when we think about mortality

10:40

and of of the has a

10:42

really high mortality rate and I

10:44

think that's what about four percent

10:46

range and so people frequently say

10:49

that have one of the highest

10:51

mortality rates of all psychiatric illnesses

10:53

and that's true and we also

10:55

see increased mortality and believe me

10:57

and or melissa at random lower

10:59

levels as well as his other

11:02

category cause. Either specified feeding her

11:04

eating disorders or. Oh,

11:07

eating disorders are really serious and he

11:09

think it is the visible components of

11:11

this one specific eating disorder and the

11:13

prominence of the in the media. And

11:15

but that doesn't diminish the significance of

11:17

the other eating disorders. The

11:20

World Of Mental Health.

11:23

Over. The last number of years. I

11:25

think of properly gotten away from you know

11:27

this yes or no To meet this criteria

11:29

are not. And. There was

11:31

talk more about the whole that are

11:34

from like almost alcoholic for that sort

11:36

of thing. Is. That consistent

11:38

with a discussion of disordered

11:40

eating. Mean. That you know

11:42

if I understand, right you're not meeting

11:45

this formal criteria. For. Just

11:47

got a problem. Can you speak or explain

11:49

to us about disordered eating and what that

11:51

looks like? him? The. Prevalence of

11:53

ah yes. For sure. So when I think

11:55

of disordered eating, I think of them in his

11:57

exhibiting some eating disorder symptoms in San. that

12:00

doesn't necessarily meet full criteria

12:03

for the eating disorder diagnosis.

12:05

So maybe, you know, I hesitate to give

12:07

specific examples of what I'm thinking just because

12:10

I know that you have a lot

12:12

of listeners and I don't want to influence any kind of thoughts

12:14

or feelings or anything like that. But

12:16

if you're finding as though, you know, my

12:19

friends don't really do this, this doesn't really feel normal,

12:21

I'm doing this because I want to influence my body

12:23

shape and weight, and you

12:25

know, that's the only thing I'm doing and I'm

12:27

not really doing anything else and it's just this

12:29

one particular thing that might be falling under the

12:31

category of like eating disorders like the solid A

12:33

more so than it would, just

12:35

like a full fledged eating disorder diagnosis.

12:37

I'm not sure if that entirely answered your

12:40

question. It's hard to, I think,

12:42

parse apart, but essentially when I conceptualize

12:44

disorder eating, I think about just symptoms

12:46

rather than a diagnosis. So not like

12:48

a syndrome level thing. We've

12:51

been talking a lot about kind of the clinical side

12:53

of eating disorders, but we have a lot of parents

12:55

that listen to the show and a

12:58

big question people will ask is

13:00

like, what are things to look

13:02

for in my kids on whether or not

13:04

they have an eating disorder? Obviously, a lot

13:06

of parents, especially when your kids become teenagers,

13:08

you're away from your child or

13:10

I guess young adult, whatever, for

13:12

most of the day, like they're not eating your vicinity and

13:14

then a lot of time, like they might not be even

13:16

eating dinner with you anymore if they're like at front houses

13:18

or whatever. So what do you encourage

13:20

people to look for? So I'll

13:22

start by saying that not everyone who does the

13:24

things that I'm about to mention has an eating

13:27

disorder. I think it's important to just note that

13:29

caveat that it's definitely possible that people are engaging

13:31

in these behaviors and don't actually need criteria

13:33

for an eating disorder. So

13:35

in terms of like psychological behavioral things, one

13:37

thing to kind of look out for is

13:39

excessive exercise. So, you know, normative

13:41

exercise is healthy for you and people,

13:43

you know, are told by our general

13:45

physicians that we should be engaging in

13:47

normative healthy exercise, but looking

13:49

for when exercise becomes driven

13:51

or compulsive. And what

13:53

that looks like is someone feels

13:56

as though they must exercise even when, you know,

13:58

the weather is bad and it's raining. they're still going to

14:01

go for a long run. Or even

14:03

if they're really sick or injured, or

14:05

if they're friends of plans, they would

14:07

miss out on those plans to go

14:09

exercise. Or they would go exercise when

14:11

they're not feeling well. Or

14:13

feeling really distressed and agitated when they

14:15

don't have the opportunity to engage in typical

14:17

exercise. So those can kind of be things to

14:19

look out for. Social

14:21

withdrawal, avoidance of social events,

14:24

especially those involving food, increased

14:26

isolation from friends and family might be another

14:29

thing to look out for. As

14:31

well as things like secretive behavior, so

14:33

hiding food, hoarding food, eating in private,

14:36

going to really great lengths to kind

14:38

of conceal eating habits from others.

14:41

Unusual food combinations. So

14:43

things like mixing really sweet foods with really savory

14:45

foods and unusual combinations.

14:47

So not something that we would

14:50

ordinarily think of mixing. Or

14:52

even like avoiding entire food groups can be

14:54

a manifestation of eating disorder symptom. And

14:57

then one that I think kind of might

14:59

be a little bit more obvious is frequent

15:01

self-weighing. So people who might weigh

15:04

themselves more than once per day, or even if

15:06

they're not weighing themselves more than once per day,

15:08

but any slight change

15:10

in the scale is accompanied

15:13

by this really severe, significant

15:15

emotional response or anxiety or

15:17

distress at this minor fluctuation on

15:19

the scale. I feel

15:21

like you've just described America. I

15:23

know, literally. And

15:26

the internet. Right. And the

15:28

internet and like all of

15:30

the conversations that Yuna and I

15:32

have had for five years now about what

15:35

it looks like out there. I'm sort of sitting there

15:37

going like, oh yeah, all right. I know someone who

15:39

does that. I know, wow. But

15:42

I was thinking, so as someone

15:45

who has struggled with an eating

15:47

disorder in the past, I feel

15:49

like I'm hyper-attuned to seeing these behaviors

15:51

in other people. And it's 100% true

15:54

that not everybody that

15:56

has these behaviors has an eating disorder. Like

15:58

I know people who are not. The proportion

16:00

by aside by the Delhi government east. they're

16:02

just like, you know, they're super into their

16:04

training or whatever. But I also know people

16:06

that I can. Clearly. Tell

16:09

that. They are currently struggling

16:11

with an inserted like right now. He.

16:14

Had it's really obvious, me and I just

16:16

haven't said anything. Because.

16:19

I know when I was going through it like

16:21

nothing anybody says said would have made a difference

16:23

to nice and that like I had to come

16:25

to the conclusion myself because like I truly like

16:27

denting, had a problem and I was just so

16:30

obsessive weight loss it didn't really matter what somebody

16:32

else I was like oh my god, I use

16:34

hostage whatever. I wouldn't care so I haven't said

16:36

anything. I know other people close to them are

16:38

very concerned as well and they also haven't said

16:41

anything even though it's kind of obvious. everybody. So.

16:43

In a situation like that, like what do

16:45

you do to help the person? like do

16:48

you contact somebody? do ask them to talk

16:50

to a therapist Like how do you talking

16:52

about it without it sounding accusatory. Reward

16:54

The The original question was what's the

16:56

parents put to look for So. I

16:59

get what points begin by noon of course

17:01

I will point to call him. Some.

17:03

Food Expert in this. Is

17:06

a really tricky thought to be Enter: have

17:08

that family member or friend struggle into not

17:10

really know how to approach and you're referencing

17:13

only sending signals as an eating disorder that

17:15

the person and sounds like knows it's totally

17:17

normal. like this is just who I am

17:19

and what I like. I just love health

17:21

and fitness. Ha is yeah exactly. Know I

17:23

think it's important to be really gentle and

17:26

recognize that you know they might not be

17:28

ready to change. They might not be ready

17:30

to acknowledge the fact that this is a

17:32

problem and and you know you could do

17:34

your best to very true. And gently approached

17:36

the subject which he is everything okay. You

17:38

know if trends notice these things, would it

17:40

be okay with you For sure. What I've

17:42

noticed is because I'm really concerned about Yale

17:44

and anything that going into that from rescission.

17:47

it's important to the person of kin is

17:49

approaching that conversation to be aware that it's.

17:51

A my not go well with so

17:53

I say that like I myself would

17:55

always tend to approach someone or even

17:57

if they're not themselves ready. To hear

17:59

me. I've never considered at home or

18:01

maybe this is the conversation that they needed

18:04

to make a change. And to realize that

18:06

other people are noticing their behavior isn't there

18:08

are really concerned. For their health. And

18:10

then this question is like super

18:12

out of left field but I just

18:15

and so serious about how the whole

18:17

owes them based. Saying. Hi to

18:19

him audio the Eating Disorder. Can a

18:21

see that we've made it through twenty

18:23

minutes before saying the word ozone? I

18:25

know, I when I know with let's

18:28

not even discuss the fact that people

18:30

who. Are as you know normally.

18:32

In don't need for medical reasons and his

18:34

news and businesslike lose another ten pounds or

18:36

whatever like that and of itself is already

18:38

like extremely problematic but I mean people who

18:40

are on these medications often times like if

18:42

you just looked at how the eat the

18:44

eat so much less because metics he says

18:46

he we're appetite right. But it.

18:49

Seems like you wouldn't qualify that isn't

18:51

enough sort or because they're not feeling

18:53

super restricted and. Attorney.

18:55

It seems a little different than you would

18:57

characterize. the is where the where somebody is

19:00

like citing all day to not eat or

19:02

purging to get rid of suits. And so

19:04

how does like to the whole wheat last

19:06

education industry impact how you see it. patients

19:08

have eating disorders or it's to his patients

19:11

count as having his or is how do

19:13

you like what if there's crossover. Between those

19:15

two. Gossiping, Really hard question

19:17

to answer and I think we're still trying

19:19

to kind of understand that because the writings

19:21

of a authentic is so new am personally

19:24

like and I you know we'd meet them

19:26

at progressively body positivity movement and like the

19:28

new generation of like teenagers feeling confident and

19:30

comfortable and and all of them families of

19:32

the kids dark at rates. For me

19:34

you can definitely be an honor. Them

19:36

back and eating that's really the to

19:39

are not mutually exclusive. We like my

19:41

decent any perjury. Of for an eating

19:43

disorder I think of other things that

19:45

require careful assessment and evaluation to understand

19:47

You know first of all what were

19:49

the motivations for for beginning of the

19:51

locked my keys in my presumably like

19:54

a doctor prescribed monkeys and what was

19:56

the rationale behind the prescription? Why did

19:58

the doctor prescribed that anything. The author

20:00

mention that people who are in

20:02

you know, average bodies have been

20:04

also relying on these we Laugh

20:07

medications which I think makes for

20:09

a little bit more the confusing

20:11

picture as like how that was

20:13

prescribed and why that was prescribed

20:15

and why the patient initiated.wouldn't really

20:17

say that. Try very carefully and

20:19

definitely not. I would never

20:21

say that because I'm Tina Funny Kitchen. They can't

20:23

possibly have an eating disorder. I would I would

20:25

wanna. That sucks. For the eyes and then and

20:28

him move. Forward accordingly. Does that answer

20:30

your question? No as I just

20:32

think it's like it's all just so

20:34

confusing now I resilience body positive he

20:36

took like ten steps forward. And the

20:38

nose and examples like ah, nevermind yeah

20:41

I know that they. Were

20:44

gonna take a quick break and come back

20:46

and speak a little bit about or so

20:48

Rex here. And.

20:55

We're back with doctor heavily. The Combat

20:57

as from Mass General Hospital. On.

21:00

The question that that I had actually becomes

21:02

from oh I don't know, just some random

21:04

house where I brought up three children as.

21:07

As a longer my wife

21:09

and we did our really

21:12

best best to provide really

21:14

good food. Using the means

21:16

that we have to have family

21:19

dinners and while also kind of

21:21

experimenting, my wife and I were

21:23

not immune from trying everything from

21:25

like whole Thirty Two The Zone

21:27

diet back in the day to

21:29

all sorts of things and part

21:31

of interests and I don't know

21:34

but we then heard that. Part.

21:36

of what we were doing was probably

21:38

interpreted. And. Became or so

21:40

rex year and are middle child.

21:43

And our daughter. Who. Has

21:46

we write up in the book? Food

21:48

we need to talk I when on

21:50

full blown anorexia. And. required

21:53

to have partial hospitalization and when we

21:55

sort of sorted it out i was

21:57

introduced to the idea of forcing next

21:59

year or sort of like, you know,

22:01

to translate it, straight eating, that our

22:04

attempt to eat cleanly sort

22:07

of went overboard. Where

22:10

did we go wrong and how can other

22:13

people avoid this? Yeah, really good question. So

22:15

I'll start with like just the definition of

22:17

orthorexia. And when we say orthorexia, typically what

22:19

we think is what you explained

22:21

is this obsession with healthy

22:23

eating and a kind of

22:25

like fixation on eating like

22:27

pure healthy foods. Orthorexia

22:30

nervosa is not a

22:32

recognized eating disorder diagnosis.

22:35

However, it does share many

22:38

similarities with anorexia nervosa. So when I

22:40

think about the criteria for anorexia nervosa,

22:42

the first criterion that you have to

22:44

meet is restriction of

22:46

energy intake relative to requirements

22:49

that leads to an underweight body

22:51

weight. It doesn't say anything about the

22:54

types of foods that you should be eating.

22:56

It's just restriction of energy

22:58

intake. So this clean healthy

23:00

eating fixation could certainly result

23:02

in restriction of energy intake if you're

23:05

eliminating other food groups for the

23:07

pursuit of eating healthy. So does it

23:09

make sense how that criterion translates?

23:11

Yes. Okay. And

23:13

then for the second criterion for anorexia nervosa

23:16

is intense fear of gaining weight

23:18

or of becoming fat, which some

23:20

people with these orthorexia symptoms might

23:23

deny. However, the second component of

23:25

that criterion is persistent behavior that

23:27

interferes with weight gain. Like

23:29

over exercising. Over exercising,

23:31

it could even be like, you know,

23:33

again, back to this healthy eating, clean eating,

23:35

not eating foods that are perceived

23:38

to be full outside of the

23:40

umbrella of clean or healthy eating. So I

23:42

don't know, something like a brownie, let's say. Because

23:45

I feel like so many people are into healthy eating. I mean, I'm

23:47

sure a lot of people listen to this podcast and healthy eating, right?

23:50

But just also like anybody you follow

23:52

on Instagram, like every influencer, whatever, everybody's

23:54

into eating healthy and blah, blah, blah. How

23:57

do you know when that crosses over into orthorexia?

24:00

This is somebody who's just like really into

24:02

whatever they think is healthy eating. Something.

24:04

That I think of the flexibility to

24:06

ever be tossed out with like German

24:08

compulsive exercise you're exercising even though my

24:10

interfere with other commitments even though you're

24:12

says even bothered. Other thing that you

24:14

should be doing or you're feeling really

24:17

sector her inches and districts when you're

24:19

not exercising. Implementing that similar kind of

24:21

conceptualization to healthy eating are you. Eating.

24:23

Like are you making food choices? At a restaurant

24:25

where all your friends are eating one thing

24:28

you are ordering something went a salad because

24:30

that literally three able to go to friends'

24:32

houses and he the see that be prepared

24:34

or does that have a lot of like

24:36

a distrust and impairment you consider not even

24:39

going as their avoid situations in which the

24:41

are healthy food your prefer. Food might

24:43

not be available deep. And a

24:45

lot of time like health of fine

24:47

food recipes I know that's enough. Sometimes

24:49

comment and pieces with eating disorders as

24:51

easy like is it. They're trying to

24:53

make a recipe for chocolate chip cookie

24:55

but you know we're replacing flower with

24:58

you know from the when almond flour

25:00

and he says that proceeding hunger and

25:02

less refined so it is according to

25:04

Strauss's causing impairment is according to avoid

25:06

other. Situations in which your preferred sued

25:08

might not be available crisis and syrup

25:10

and plead guilty to a new for

25:12

a new. Thing.

25:15

For me, I'm really into health a

25:17

fine. Ss

25:19

so many new as eating disorder I I

25:22

I don't think I have been. how do

25:24

you know what is the site eyes own?

25:26

I am and I'm just by way of

25:28

introduction like I'm I'm not much of a

25:30

cook for her. hope of Baker. I'm

25:33

a really good sous chef. And. I

25:35

help my wife and everything and I could tell you that

25:37

you could use apple sauce and. And

25:39

in lieu of some of the oil and

25:41

then we definitely she would trade out. You.

25:44

Know different flowers and always use

25:46

a lot less of this is

25:48

and show her such as recommended

25:50

because we'd widow prefer that sweet

25:52

let me buy a house of

25:54

for as guilty. As. Like you know

25:56

this is I think the difference for me for a

25:58

lot of things that I. The same way

26:00

I do like I straddle this weird

26:03

line ran like I don't feel anywhere

26:05

near what I saw like when a

26:07

honey disorders but then I'll be like

26:09

oh no I'm doing this is an

26:11

eating disorder and with know because it's

26:14

not causing me to have emotional distress

26:16

places before it was so tied to

26:18

like in xiety around me and eating

26:20

unhealthy foods and like if this and

26:22

that catastrophizing all the time whereas like.

26:25

I don't know I saw you do it. You're like

26:27

your joyful in the way that you are as I

26:29

get sick, more fun when you're baking, you're trying to

26:31

figure out of my disease or whatever. Anyways, that's just

26:34

kind of how I think about a barrier against the

26:36

let dogs. Are different subs are but as of

26:38

June and I go on your the expert.

26:40

Yes, as easy as is a lack of

26:42

the stress of mixes not an eating disorder.

26:44

I would encourage you to think about Iraq

26:46

against. And here but are encouraged to think about

26:48

how you would felt if you couldn't either thing

26:50

as he couldn't that the to your oil for

26:52

applesauce if you couldn't cut down on you know

26:55

the sugar you're putting your big that would you

26:57

still eat them. Would you still enjoy that with

26:59

that cause you. Soviet as yes yes you

27:01

can ask and yes I will answer

27:03

is when we cook something like Indian

27:05

food at home. We you know

27:08

health of I am week so the cut

27:10

back on the oils and though the butter

27:12

and then occasionally. We'll. Eat out

27:14

and will bring in the still hisses

27:16

Indian food. Were. Clearly they've used all

27:18

the g in the world or whatever butter they

27:20

want and it's. Wonderful

27:22

and I and I enjoy it.

27:25

Now we choose again not to

27:27

eat that frequently. But.

27:29

I'm I saw I don't

27:32

outside so feel badly. Ah,

27:34

or marketable. You can eat at one

27:37

way you can either than others. Your personal

27:39

preference for your phone has to do at

27:41

this one. Man, that's okay Again, just as

27:43

long as it's know club new to avoid

27:45

eating. Out at the Indian restaurant that you the like the

27:47

right like if he were to say to me no no

27:49

no I could never be. Tense, What about all

27:52

the announces after using? I'm not using

27:54

all? Just Me. Get Home. That's definitely

27:56

something. And like that's a red flag.

27:58

right on a problem? But

28:00

you're describing it as that, this delicious thing

28:02

that you've done, and it's wonderful when you

28:04

eat it. You just choose not to eat

28:07

it all the time. And that's

28:09

okay. That feels healthy to me. That feels

28:11

like you have a healthy relationship with

28:13

food. Does that feel

28:15

consistent with what you're experiencing? Yes. And

28:17

I'll let you talk in just a

28:20

second, but I'll just share one other

28:22

thing. I've had the opportunity to travel

28:24

overseas, the last few months, one trip to

28:26

the Middle East and one trip to South America,

28:28

and what I was struck by is

28:30

that when people offer you dinner, it's

28:34

not like a whole discussion and

28:36

disclosure and fine... But your dietary

28:38

preferences? Dietary preferences of what will

28:41

you eat, what can't you eat, what don't

28:43

you choose to eat, how much

28:45

healthifying do we need to do, as I

28:47

would now learn to say. And it's just

28:49

sort of like, here's dinner. And

28:51

I actually tried a new diet. I think I shared

28:54

this with you on these trips,

28:56

which I never ever do,

28:58

which is, if it's offered, I will try it.

29:00

Sounds great. Yeah,

29:02

I tasted things that I never thought that

29:04

I would taste before. And I just sort

29:07

of tried to do as

29:09

they were doing in the... When

29:12

in Rome, it was the Romans, and just sort of

29:14

say, you eat the food that's put in front of

29:16

you and you engage in conversation and not remorse.

29:20

That's like the only

29:22

way to travel, honestly. Because you can't... You'll

29:24

be so miserable trying to restrict your travels

29:26

to your food at home. Also, it's one

29:29

of the fun parts of traveling, is trying

29:31

new foods. I think you learn a lot

29:33

about culture through food. And so having the

29:35

ability to just say yes to anything you're

29:38

offered probably gives you a really rich cultural

29:40

experience. Yeah, totally. I just

29:42

had a quick question about misconceptions around eating

29:44

disorders as we kind of wrap up. What

29:47

do you think are some of the biggest misconceptions around eating

29:50

disorders that we have in the public? Yeah, so

29:52

I'll start with one of the big ones,

29:54

which is for bulimia nervosa. The

29:56

misconception that I'd like to talk about is the fact

29:58

that... People think I

30:01

believe it or of the you have

30:03

to be purging three vomiting and were

30:05

to be creature yeah hurt or so

30:07

and we think about believe me on

30:10

a binge and bomb it has he

30:12

not true So individual can increase your

30:14

ear for boeing interval sad by compensatory

30:17

the hear that includes non purging method

30:19

and purging method. So anything purging. The

30:21

term purging is an umbrella term for

30:23

things like laughs it as an vomiting

30:26

and ironic you still purging. Does not

30:28

been vomiting First of all. And

30:30

as for non hurry jangling intervals that

30:32

you can use these and compensatory behaviors

30:35

like gang which is defined as going

30:37

for eight or more weekend hours without

30:39

eating anything and engaging and driven in

30:41

excess of exercise following a bench and

30:44

this still classified as an upcoming and

30:46

story behavior seat and still meet criteria

30:48

even though you're not bomb ng so

30:50

that kind of like one willing pop

30:52

culture one that has been too busy

30:55

we typically think oh believe me out

30:57

there definitely gonna hang of his last

30:59

one. Misconception are and then what's another one

31:01

asking how old would have been eating disorder

31:03

and path through a little bit what binge

31:05

eating actually is the of eating. A lot

31:07

of people can use that term colloquial, even.

31:09

They've just enormous soon. So when

31:12

we think about that, objectives, binge

31:14

eating means. It means

31:16

eating an objective li large amount

31:18

of food. In a short

31:20

period of time and experiencing a sense

31:23

of loss of control the feeling as

31:25

though you cannot stop eating and which

31:27

is very different from kind of like

31:29

normative over again and both binge eating

31:32

disorder and bullying and of of that

31:34

and the bench purchase of type of

31:36

anorexia nervosa are characterized by these would

31:38

prefer. Eating subjectively

31:41

large amounts of food. So again, not

31:43

just like your comment. Place over eating

31:45

that we're all kind of like guilt feeling,

31:48

teaching and occasionally so it's just a moment

31:50

ago you brought up. Another

31:53

whole. Area. Of

31:55

fasting. And. We've

31:57

done separate shows on this island.

32:00

Fascinated by. The.

32:02

Popularity of intermittent fasting

32:04

by. And and

32:06

of courses for the listeners will know

32:08

that there's everything from Stone Snack after

32:11

dinner. And. Have a proper

32:13

in overnight and then break your fast

32:15

in the morning. That sounds all healthier

32:17

to me down to only eat for

32:20

a. A. Feeding window of whether

32:22

it's twelve hours or ten hours.

32:24

Or eight hours or six hours.

32:26

Whatever. With. Did you suggest

32:28

that there's actually a number of like if

32:30

you don't eat after waking up for certain

32:32

number of hours of than you. Qualify

32:35

for some sort of eating disorder. So any

32:37

eating a third the world and and

32:39

had to sign that same as going

32:41

for eight or more written our it's

32:44

about little. Anything in order to implement

32:46

your body suddenly. The. Doesn't necessarily

32:48

mean criteria for any the wizards

32:50

as and behavior that we can

32:52

look out for Enough to an

32:54

operational definition that we used to

32:56

a fancy people are reporting the

32:58

air. And if I or

33:00

listener were to not. Eat

33:02

for the eight hours after while being

33:04

awake, but not necessary to lose weight,

33:07

but because it's believed to be or

33:09

there's some signs that shows that it's

33:11

healthy. That. Would not meet that

33:13

criteria Them: As a. Hobby.

33:17

Or as out. Just

33:19

as it's kind of taken and rather than

33:22

I modify them a little bit more about

33:24

what you're kind of thinking and it's healthy

33:26

and wire doing And the yeah, And.

33:28

Then what are the most current events for

33:30

eating disorders Know really good person typically will

33:32

use families the predatory that's and for patients

33:34

here zealand under sixteen or have a lot

33:36

of wheat to gain and an individualized treatments

33:39

for he says you don't have a lot

33:41

of each again or are older and can

33:43

and of engage in the treatment of the

33:45

support that their family. Members and from his

33:47

be able to be for eating. Disorders is

33:49

one option that has a really good

33:51

evidence to support is actually really exciting.

33:54

We were moving towards more abbreviated versions

33:56

of this treatment of typically it with

33:58

him and twenty to thirty. The him

34:00

and we have no treatment. that only

34:02

concessions long and it seems to be

34:05

working just as well as the originals

34:07

hundred and thirty session version. That treatment

34:09

and feeling it's treatment for particularly Anorexia

34:11

Nervosa. The younger individuals have eating disorders

34:14

you need our family support have a

34:16

lot of way. To Gain and the

34:18

and also a pretty common and good

34:20

as a key them for eating disorders

34:22

it's fall. And. With that guys

34:24

we are out of high on our episode is

34:26

so as far as I've of I now but

34:28

we're going to go over to the membership and

34:31

we're going to do a whole episode on actually

34:33

been cheating which we just talked about and what

34:35

to do after you binge eat. So first of

34:37

all I want to say thank you so much

34:39

as enough for me on today's episode it was

34:41

so have fun for his own people and will

34:43

link to her on our website. Thank you for

34:45

coming on I hear things you for having me

34:47

and with them. If

34:51

he wants to hear our bonus episode

34:53

called within. So now what had over

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the link in our show notes. You

34:59

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35:03

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