Ep 93: How to Spot & Treat Eating Disorders

Lauren Muhlheim, author of When Your Teen Has an Eating Disorder
and clinical psychologist, speaks with Andy on spotting and
treating eating disorders in teens. Eating disorders are scary,
but Lauren tells us that together, families can reduce the
dangers and stress eating disorders cause.


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Full show notes


For the average person, there is absolutely nothing frightening
about pizza. It’s delicious, cheap to order, and easy to eat! So
why might pizza be such a struggle for a teenager with an eating
disorder?


Pizza is high in calories and fat, and can be very triggering for
someone who constantly obsesses over what they eat. Pizza is also
the go-to food for birthday parties, school events, or college
activities. It’s one of the most frequently eaten foods in
American culture. For a teenager with an eating disorder,
adjusting to regular life means eating pizza--and for them, this
is isn’t easy.


That’s why we need to take teen eating disorder treatment
seriously, and help those suffering from anorexia, bulimia, or
binge eating as soon as possible. By waiting too long to address
these problems, or letting teenagers struggle with them alone,
their physical and mental health can only get worse. It can
become so serious that even something as simple as pizza at a
school event can become a battleground.


My guest today is Lauren Muhlheim, clinical psychologist and
expert on teen eating disorder treatment. She recently authored
When Your Teen Has an Eating Disorder: Practical Strategies to
Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating.
The book dives into a lot of information about eating disorder
recovery, focusing mainly on the idea of family-based treatment.


You may be familiar with the term family therapy, in which a
family undergoes treatment together to work out issues they may
be having with one another. Although they may sound similar,
family therapy and family-based treatment are actually very
different. When it comes to teen eating disorder treatment,
family therapy focuses on the cause of the disorder, viewing
family issues as the underlying problem. This kind of treatment
usually only looks at the family as the cause, and places the
solution in the hands of residential or other professional
treatment. Family based treatment focuses on how families can set
up structures and systems to help their teen heal physically and
mentally. In this type of therapy, families essentially become
the residential treatment; they are the ones who monitor eating,
take measures to inhibit purging, or whatever the teenager may
need.


This kind of therapy is derived from research done in the U.K. in
the 90s, before being brought over to the U.S., to be studied by
researchers at Stanford University. Previously, family therapy
was the most widely spread treatment for eating disorders, going
back as far as the 1600s. For centuries, teenagers have been
leaving their homes to get residential treatment for eating
disorders, and then returning home only to relapse. Many times,
this can be attributed to losing the structure of in-patient
therapy and suddenly being left to their own devices. Family
based treatment was invented to stop this issue, and is now the
most researched form of teen eating disorder treatment.


For parents, the idea of family-based therapy should be
encouraging, not disheartening. This means that you are part of
the solution, that there are steps you can take to help your
child! You have the ability to guide your teenager through this
difficult period.


So where can we as parents start when it comes to stopping eating
disorders in our homes?


The first step is to watch your teenager closely and take any
sign of an eating disorder seriously. One of the most important
things to prevent a disorder from worsening, according to Lauren,
is to not wait too long. She mentions that some pediatricians or
doctors may tell parents to wait for more symptoms to arise
before truly taking the disorder seriously, but if a parent waits
too long, the disorder can become so bad that it takes a teenager
years to recover. This problem is particularly bad when it comes
to teens and anorexia. She mentions that there are no negative
repercussions for having a talk with your child about eating
habits and the possibility of an eating disorders, and that it’s
much better to do so then to sit back and allow the problem to
unfold.


Lauren says be careful not to be so affected by diet culture that
you are more nervous about your teenager gaining weight than
losing it. You might regard low weight as positive thing or a
sign of health, but it’s important to pay close attention to
teenager’s habits to make sure they aren’t treating their bodies
poorly. Lauren also emphasizes watching teen’s trajectory along
their growth and height charts. If you’re paying attention and
checking regularly, you are more likely to notice when your
teenager seems to take an unhealthy dip in their growth. Lauren
stresses that a teen who is staying the same size can sometimes
be just as bad as an adult who is drastically losing weight.
Teenagers are supposed to be gaining weight to keep up with their
growth and not doing so could be dangerous. Noticing anything
that concerns you may be a good sign that you should seek teen
eating disorder treatment.


If you decide to try family-based therapy, the best way to start
is to help your teen get back to their healthy weight. Lauren
equates food to medicine for teen eating disorder treatment; The
anxiety and depression teenagers feel when they get stuck in an
eating disorder is largely caused by malnutrition. Lauren and I
discuss a groundbreaking study in which men in their 20s with
great physical and mental health had their caloric intake cut by
50% for six months. As a result of their poor nutrition, they
became extremely anxious, depressed and obsessed with food.


This state is called negative energy balance: someone is eating
too little or exercising too much instead of maintaining healthy
habits and feels physical and mental effects. For those who are
predisposed to developing eating disorders and find themselves
with negative energy balance, these physical and mental issues
and lack of nutrition become a brutal cycle from which they
cannot escape. This is why Lauren says getting teenagers fed is
the priority when it comes to teen eating disorder treatment.


You may be wondering, how can I get a teenager to eat regular,
balanced meals if they were previously diagnosed with a disorder
that is defined by their adversity to eating? Taking a strong
stance and imposing structure may cause a lot of tension between
you and your teen, but it’s much better than allowing the
disorder to continue to manifest. The key is to have lots of
structure and supervision. Starting with three meals and three
snacks a day is a good start. Some teenagers may need to
replenish weight they’ve lost or failed to gain because of their
disorder. In some cases, they may have become hypermetabolic. In
these situations, teenagers may need to eat as much as 3,000 or
6,000 calories a day. It may seem like a lot, but taking these
steps is going to help your teen be happy and healthy so they can
reach their full potential!


Supervising your teen to make sure they eat is one of the best
ways to help them fix their negative energy balance and recover.
This can mean making sure they eat at home, but in s...