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.

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 serious cases, this can also include supervising meals they normally eat at school by picking students up before lunch period and having them eat in your car or watching them eat with friends over facetime. Supervision can also e...