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Good Inside with Dr. BeckyGood Inside with Dr. Becky

When Food Feels Scary: Eating Disorders in Kids & Teens (Early Signs & What Helps)

Eating disorders affect an estimated 30 million Americans in their lifetime. They are common. They are serious. And they are not caused by “bad parenting.”Dr. Sheryl revisits a recent conversation between Dr. Becky and Dr. Erin Parks, Chief Clinical Officer at Equip Health, to talk about eating disorders and disordered eating in kids and teens—what the early signs look like, what’s happening emotionally underneath, and how parents can respond without escalating shame or control struggles. In this episode, we cover: - Early warning signs of eating disorders in kids and teens (including boys) - When “healthy eating” becomes rigid or concerning - The role of perfectionism and control - How diet culture shows up in family language - What shame sounds like inside a teen’s head - How to hold boundaries around health without turning food into a power struggle - When it’s time to seek professional help Disordered eating behaviors are not about vanity or defiance—they’re often attempts to regulate overwhelming feelings. This conversation will help you feel more oriented, more compassionate, and clearer about your role.Equip Health is a sponsor of "The In-Between Years."Learn more about [Good Inside](http://www.goodinside.com/?utm_source=podcast_teen&utm_medium=podcast&utm_campaign=teen_evergreen&utm_content=shownotes_20260422_Equip).

Dr. Erin Parksguest
Apr 22, 202641mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 1:00

    Sponsor: Equip virtual eating disorder treatment—what it is and how it helps

    1. BE

      Eating disorders don't always look the way we expect. As parents, sometimes the hardest part isn't noticing something feels off, it's figuring out what to do next. Early support can make a real difference, but finding help is often confusing, slow, or disruptive. That's why I'm excited to tell you about Equip, a virtual eating disorder treatment program that helps your child recover at home with a full care team and support for you as parents every step of the way. Equip treats all eating disorders, works with all ages, has no wait list, and is covered by insurance in all 50 states. If you're worried about your child and don't know where to start, visit equip.health/goodinside to learn more about Equip's eating disorder treatment. That's equip.health/goodinside. Welcome to The In-Between Years from Good Inside.

  2. 1:00 – 3:02

    Why “Is this a thing or am I overreacting?” often signals it’s time to pay attention

    1. BE

      I'm Dr. Sheryl. If you've ever had the thought, "Is this a thing, or am I overreacting?" you're already in the moment this episode is about. In this case, the topic is food. A kid who suddenly cares a lot about eating clean, a teen who skips dessert without a second thought, a shift that's subtle enough to explain away, but persistent enough that you keep thinking about it. So much of what kids are picking up right now actually sounds like discipline or health or doing the right thing, which means a lot of parents hesitate. They wait. They try to figure out if they're making too big a deal of something that might just pass. But as you'll hear in this conversation, by the time you're asking those questions out loud, there's usually something worth paying attention to. Eating disorders and disordered eating are far more common than most of us realize. They affect an estimated 30 million American men and women over the course of their lifetimes. One in five teens struggle with unhealthy thoughts or behaviors around food or their bodies, which means if you're listening to this, this topic probably touches your life. This conversation originally aired on Good Inside with Dr. Becky, but it's so packed with insight and refreshing honesty that I wanted to make sure you heard it. Dr. Becky talks to Dr. Erin Parks, a clinical psychologist who works closely with teens and families around eating disorders. Before we get into it, I wanna be transparent about one thing. Equip Health, where Dr. Parks works, is a sponsor of this podcast this season, and also, this is exactly the kind of conversation I want parents to hear on this podcast. It's grounded, it's practical, and it helps you move out of that stuck place of, do

  3. 3:02 – 4:51

    What clinicians are seeing now: more picky eating and more body/food control

    1. BE

      I act or do I wait? Let's go. Okay, so many things I wanna ask you, but I just wanna kind of ground this conversation around eating disorders, disordered eating with what you're really seeing right now with families, teens, younger kids around food. Like, what is showing up most, and what's kind of most pressing, most relevant right now?

    2. EP

      I think the two things is that, first of all, it's increasing and more of it, and I hear parents worrying about either their child's picky eating.

    3. BE

      Mm-hmm.

    4. EP

      Is this a problem? Is this not a problem? It seems to be getting worse. Or about how their kids are feeling about their bodies and trying to eat healthier and control what they eat.

    5. BE

      Hmm.

    6. EP

      The parents are asking me, "Should I worry, or should I be celebrating?"

    7. BE

      Hmm.

    8. EP

      Those are the two things I'm probably hearing the most.

    9. BE

      Increase in picky eating and-

    10. EP

      Increase in picky eating

    11. BE

      ... and in eating disorders, overlap?

    12. EP

      And in eating disorders.

    13. BE

      Yeah.

    14. EP

      The rates of eating disorders have been steady for about 100 years-

    15. BE

      Hmm

    16. EP

      ... and since 2020 have been going up, up, and up.

    17. BE

      Hmm. And then this other category of things, not to say that there's not overlap, I just wanna see if I'm getting this right to mirror back, is there's this category of, like, my kid wants to eat healthier, and is, is healthy something to celebrate? Is healthy sometimes a cover for control or rigidity? Is that kind of the, the debate, the space you're seeing a lot of as well?

    18. EP

      Exactly, because there's so much content coming out right now about the correct way to eat, the correct way to feed your kid, and I'm having parents say to me, "My kid is freaking out," 'cause they're like, "If kale is healthier than spinach, should I not eat spinach and only eat kale?"

    19. BE

      Hmm.

    20. EP

      And they want to do the right thing as parents, and then the kids want to do the right thing as kids.

    21. BE

      Yeah.

    22. EP

      And yet, what is right is very much in air quotes-

    23. BE

      Yeah

    24. EP

      ... because there is no one right way to eat.

  4. 4:51 – 7:22

    When “healthy eating” is actually restriction: the add-vs-take-away test

    1. BE

      Well, I wanna actually take what you said and the categories then and maybe jump into them one at a time. Let's start with what you just ended with, healthy eating or rules around eating, or one of the things I think about a lot is morality around eating. [laughs] Right? I always think with parents it's like morality is often the thing we want to avoid, right?

    2. EP

      Mm-hmm.

    3. BE

      Um, what are the good foods, right? What... Is it kale and spinach, or is it no carb or no this or fat, or there's always some latest thing. And so just when a parent comes to you and they're like, "Is this something I should be concerned about?" or, "How should I intervene?" Just walk me through, like, if I'm saying that to you, okay? I'm seeing my kid come. "I don't buy that anymore, and this isn't good, and I read this thing online. I saw this thing on TikTok. My friends aren't eating this food anymore." And I'm saying to you, "Okay, is, is this a good thing? Is my kid becoming more empowered? I- is this a concerning thing?" Just talk to me.

    4. EP

      By the time a parent asks me, even if it's just on the soccer field, "Is this a problem?" answer's almost always yes. I really can count on one hand how many times the answer is no. There's something about us as parents that when our gut says something is off about food, we don't listen to it right away.

    5. BE

      Hmm.

    6. EP

      Because we're consuming the same diet culture. We've been drinking from this fountain of look different, look younger, be smaller since we were also born. And so when we see these behaviors in our kid, our gut says something's wrong, and then we start saying, "Okay, it's probably just a phase." Probably making too big deal, too big of a deal out of it. So by the time I finally say it out loud to someone, the answer is yes. Yes, you should be trusting your gut. Yes, something is off.

    7. BE

      Mm. Yeah. And my guess is also it's not always a binary. No, it's not a problem. Yes, it is a problem. Hey, there's something rising to the level of your gut thing. You're thinking about it. You're wondering about it. Like, let's just be more curious about it. Let's look into that together, as opposed to either/or.

    8. EP

      Exactly. So if your child is saying, "I want to eat healthier," and what that looks like is they start eating a wider variety of food. They start eating what you are eating at dinner.

    9. BE

      Mm-hmm.

    10. EP

      They start ordering, um, new things on the menu when you go out to a restaurant. That probably doesn't make you worry, and that is a form of eating healthier.

    11. BE

      Mm.

    12. EP

      But when your child says they wanna eat healthier and they're no longer eating birthday cake at their cousin's birthday party, they are stopping eating their favorite foods, you're concerned they might be losing weight, that's when your gut is saying, "Wait, this eating healthier isn't a good thing." So your gut naturally goes off when you're picking up on them taking away things they used to do, instead of simply adding.

  5. 7:22 – 9:31

    What to do next: start the conversation early and keep it ongoing

    1. BE

      And I'm just pictur- I'm picturing this parent with this kid. What comes next? Like, let's say a parent's thinking, "Okay, this whole shift is maybe under the cover. It's been labeled healthy, but there's something in me saying, I don't know, seems a little different from just that." Do I, do I just notice for a couple weeks? Do I collect some kind of data? Do I talk to my kid right away? If I do, you know, what would that be? I'm gonna put on another option on. Do, do I say, "I made a new appointment with a, with a therapist and a nutritionist, and you need to do that." Like, how... What are the next steps?

    2. EP

      I would talk about it frequently, and I would start now-

    3. BE

      Mm

    4. EP

      ... because it's something that all of us are constantly receiving information about how we should eat, how our bodies should look, and so it can also be a constant conversation in your home. So when your kid tells you they wanna be healthier, I usually ask, "Well, tell me what that means. I'd love to help. We all wanna be healthy."

    5. BE

      Mm-hmm.

    6. EP

      Healthier can mean going to bed at an earlier time, which is usually not what a teenager means when they say they wanna eat healthier or be healthier.

    7. BE

      Healthier. Mm-hmm.

    8. EP

      But reminding people that eating healthier is one aspect of health, and seeing is health what they're really after.

    9. BE

      Mm-hmm.

    10. EP

      I also like to ask them why. And I will hear-

    11. BE

      Yeah

    12. EP

      ... things like, "Oh, I wanna be faster at my sport," or, "Well, I don't really know, but everyone's just... I mean, I should, shouldn't I?" And that tells me something, too.

    13. BE

      Mm.

    14. EP

      This I should. They're already shoulding themselves. They're already deciding that there's a good way to be and a bad way to be, and they think that eating a certain way, and it goes to your earlier point around the morality of food. And we need... I'm, I mean, I am a human who grew up in America and a woman who's trying to embrace aging while not wanting to age, right? So I, I get the mixed messages that we all receive. Um, but it's, it's really, really difficult, and we accidentally say, "I ate well," "I ate poorly." Um, "I, ugh, I'm gonna eat so poorly at the Super Bowl party," or, "I ate bad at the party."

    15. BE

      Mm. Mm-hmm.

    16. EP

      Um, and so the kids are around this moralization, and the behavior that they claim to want, like eat healthier, be healthier, is sometimes about trying to be perfect, be better-

    17. BE

      Yep

    18. EP

      ... find a binary that doesn't really exist.

  6. 9:31 – 11:56

    Untangling food morality at home (sugar, gluten, and rigid rules)

    1. BE

      I, I just wanna double click on this morality thing, because I know I've talked to parents who will say to me, and I'm sure you hear this all the time, "But sugar is bad," but, um, um, I, my kid doesn't have celiac, but gluten is bad. Gluten leads to inflammation. And, a- and I'm not here to debate any of those truths, but I'm sure that comes up a lot, where how, how do I figure out food and morality, especially if there are families and adults who, who really do believe and, and maybe with good data. Like, but, but why can't we talk about things as good or bad if there's certain data or science to support that? How do you manage? I'm sure... And do you see that?

    2. EP

      I s- see it constantly.

    3. BE

      [laughs]

    4. EP

      I mean, I live in Southern California. [laughs]

    5. BE

      Right. [laughs]

    6. EP

      Like, land of no sugar and no gluten.

    7. BE

      [laughs]

    8. EP

      Um, it's hard. I really, really personally struggle with it, because I remember the '90s when bagels were a healthy breakfast item, and I miss it. My 14-year-old son came home-

    9. BE

      Mm-hmm

    10. EP

      ... and, you know, he's newly at high school, and I can feel him picking some stuff up, and he has been more cautious around the sugar. And so I asked him, I'm like, "Max, what's going on here?" And he's like, "I'm like, I know of friends who just don't eat sugar."

    11. BE

      Yeah.

    12. EP

      "And you seem to feed us so much sugar."

    13. BE

      Yeah.

    14. EP

      And I'm like, "You're welcome."

    15. BE

      [laughs]

    16. EP

      "That's what you sh- I would like to hear a thank you." No, but I... Kids want to do the right thing, and so when I talk to other kids or parents about it, I remind them that while you are still developing, the number one thing you need is calories, period. And where are calories? They're in sugar. They're in carbs. That's where calories are. If you were anemic, I would be figuring out how to get you more iron.

    17. BE

      Mm. Mm-hmm.

    18. EP

      But what you are doing is going through growth spurts.

    19. BE

      Yeah.

    20. EP

      They have so much movement between walking to classes and all the activities they're in and the sports, and they are growing. So what they need is calories, so the healthiest thing is calories, and the easiest way to get that for them is carbs and sugar.

    21. BE

      Mm-hmm.

    22. EP

      If, as a family, you're deciding to be gluten-free or sugar-free-

    23. BE

      Yeah

    24. EP

      ... there are all sorts of different ways to feed your kids. Uh, we do a lot of cancer metaphors in the eating disorder community, and I like to remind people that we would never give our child poison unless they had cancer and needed chemotherapy.

    25. BE

      Mm.

    26. EP

      So similarly, if in your household you're like, "We don't eat gluten," or, "We don't eat sugar," but I'm gonna make this change because my child now needs something that is different because they've developed an eating disorder or their disordered eating is making us-

    27. BE

      Yeah

    28. EP

      ... worried about their health.

  7. 11:56 – 13:47

    Your child is watching: align what you say with what you model

    1. BE

      I think that's really helpful. And, and one more level practical. For the parents who are thinking, "How do I manage a situation actively where it's true, my kid notices I'm not eating a certain thing, but I don't want that to be fully absorbed by them?" Like, what language do you recommend people use, or what type of conversation starters?

    2. EP

      I think it's two things. Sometimes it's what you say, and sometimes it's adjusting your behaviors.

    3. BE

      Hmm.

    4. EP

      Um, my child once saw me not finish a milkshake, and I heard about it for a month. Um, you know, he knows that I have struggled with disordered eating before, an eating disorder before, and it made him hyper-aware. And I had no idea that he knew any of these things, that he even paid attention to what I did for a living. Um, and so they're always observing, even when we think they aren't.

    5. BE

      Yeah.

    6. EP

      So sometimes the solution is to talk to them about it and say, "Hey," you know, I use the sports metaphors as well. You're gonna have kids on your soccer team who have knee issues. They're going to do stretches that you don't do before and after practice, and that kinda stinks for them. Like, they have to spend this extra 30 minutes doing this and that. That is what they have to do 'cause of their knee issue. Well, maybe there are people in our household who eat different for different reasons. Maybe Dad is watching his cholesterol for health reasons, and so he has eliminated some foods.

    7. BE

      Mm-hmm.

    8. EP

      That's what he has to do. And though sometimes the solution is also examining your own food habits-

    9. BE

      Yeah

    10. EP

      ... and the ways in which they're communicating things you don't want your kids absorbing.

    11. BE

      I, I, I just wanna say, Erin, I really love the, the very reality-based part of that answer. And, uh, there are times when, yes, we can label it to our kids. You're right, I'm not eating this, and I have my reasons, and look in our family in general, we believe that the way I do things shouldn't always be the way you do things. We actually love the way [laughs] you guys do things differently as kids. And then there's other times where it is true. If you never eat certain types of food or if it feels very rigid, that behavior sometimes

  8. 13:47 – 16:59

    Control, anxiety, and the “superpower” that can flip into risk

    1. BE

      speaks louder than anything we say. And if you have a kid who's especially observant or especially people-pleasing or especially looking at me all the time and becoming rigid, sometimes there's nothing that I can say that's gonna be as powerful to my kid as saying, "I'm gonna have dessert tonight," right? And, and there's a reality of that that I think it's, like, okay to just name. So we're kind of along this topic, and I wanna transition to it. Control. How do you see the relationship between disordered eating, eating disorders proper, control? What... Are there any signs that a kid, way before eating stuff develops, might be prone to them given their relationship with control in general?

    2. EP

      A lot of people who struggle with eating disorders also struggle with anxiety.

    3. BE

      Mm-hmm.

    4. EP

      So they wanna do things right. They wanna do things perfectly. So that might be something you see early on.

    5. BE

      Hmm.

    6. EP

      They see anxiety around perfectionism, anxiety, um, rigidity. Uh, we also see something, it's a fancy word for knowing when you need to pee, but this altered interoceptive awareness. So these are the kids who can play sports through an injury. They can stay up studying through the fatigue. They can ignore the calls and the social plans of their friends and just keep working on that project.

    7. BE

      Hmm.

    8. EP

      That is an incredible skill. I think a lot of success comes from having this tunnel vision, and if you take that tunnel vision and direct it towards changing your body or changing the number on a scale, that's exactly what I think is so hard as a parent, is you're like, "I wanna praise that they stayed in the gym the extra hour. I want to praise that they stayed up late working on that project." And at what point are we praising behaviors that we don't wanna see in ourselves as adults? We all talk about trying to figure out how to turn off, about how to know our own intrinsic worth, but what we're doing is praising behaviors that can lead to burnout, can lead to an eating disorder. I really caution people around exercise. When you see your kid exercising despite be- having an injury, exercising longer than their friends-

    9. BE

      Hmm

    10. EP

      ... especially in boys and men, so I just wanna remind people that 40% of people with eating disorders are male, so this is affecting teen boys just-

    11. BE

      Yeah

    12. EP

      ... as much as teen girls. But it's usually missed in boys, because when a boy stays longer in the gym, it's praised. Um, and then especially if you're at the gym instead of going to a social activity, w- what's better for a 15-year-old's development than going and seeing friends in person, something we want all of our kids to do more of? Not being in the gym.

    13. BE

      And look, and, and just for all the parents listening, right, I think, look, there's part of that that of course at moments you're gonna say, "Wow, you're working really hard," right? So I, I think again, and I think we're similar, no, no rigidity [laughs] there either as a parent. But it's just such a good moment as a parent to pause and say, "Okay," if I have a kid like that, and it's like, "Oh, my goodness, Erin, are you talking about my kid?" Ah, is there just a nuance there I want to reflect on, even if I don't change anything yet? Yeah, it's kind of amazing. My kid pushes past the type of signal or pain that would stop someone else in their tracks. That can be used as a superpower, but ooh, that also, [laughs] that could flip on them, too. And if I think about it in that nuanced way, maybe there are moments instead of just praising, I say, "Hold on a second."

  9. 16:59 – 17:59

    The neurobiology angle: what’s inherited and how to model balance

    1. EP

      One of the things that's unique about eating disorders is we haven't really found a gene, per se, that's passed from parent to kids.

    2. BE

      Yep.

    3. EP

      But we know it's very heritable, like 86%, I wanna say, 85, 86. Um, but what we have found is that it's a neurobiological-based illness-

    4. BE

      Hmm

    5. EP

      ... and so that the pathways in the brain that are in charge of things like interoceptive awareness-

    6. BE

      Hmm

    7. EP

      ... um, attention to detail, that is what's being passed on. So if your kid has these behaviors, there's really high chances you do, too.

    8. BE

      Yeah.

    9. EP

      And it gives you an opportunity to say, like, I'm sure our children have seen both of us push through fatigue and get work done.

    10. BE

      Yeah.

    11. EP

      And I'm proud of that.

    12. BE

      Of course.

    13. EP

      I'm glad that they've been able to see that, but how can I also make sure I'm saying to them, "I'm burnt out and I'm exhausted. Mom's been on too many planes. Mom stayed up too late too many nights in a row. I'm going to go hang out with my sisters. I'm going to skip work tomorrow-

    14. BE

      Mm-hmm

    15. EP

      ... and do something fun." And so it's modeling for them, figuring out when to use it as a superpower and when it's starting to hurt my quality of life.

  10. 17:59 – 21:39

    Why disordered eating behaviors ‘work’ (until they don’t): emotion regulation

    1. BE

      Can you help us understand, I know parents, they see a kid restricting, obsessing about food, binging, these things that logically it feels like, "Why, why are you doing that? Like, stop doing that." But there's something kids are getting from that or something it's doing.

    2. EP

      One of my favorite things in how I fell into eating disorders is because they really are about regulating emotions. And as someone who has very big emotions, I, um- I love just the honest talking about the ways in which eating disorder behaviors really serve people. They work until they don't work anymore.

    3. BE

      Yep.

    4. EP

      So what we see from a lot of [clears throat] the kids and teenagers that we work with is that they experience the same emotions as everyone else, but just at a louder volume. And if you are genetically predisposed to have an eating disorder-

    5. BE

      Yep

    6. EP

      ... [clears throat] and you might find that when you're really stressed out, not eating actually makes you feel better.

    7. BE

      Mm.

    8. EP

      So for most people, if you don't eat, you maybe get hangry, you get grumpy. Um, but for people who are prone to have an eating disorder, not eating actually relaxes you. I w- tell parents, I'm like, "Imagine you're gonna go on stage and give a presentation to 100 people, 500 people, whatever's gonna terrify you, and if someone offered you your favorite breakfast right before you went on stage," you'd be like, "Absolutely not." Your stomach would be in knots. You wanna eat that afterwards. Well, that's what the stomach of someone with an eating disorder or who's prone to have an eating disorder often feels like, so not eating actually relaxes them-

    9. BE

      Mm

    10. EP

      ... regulates their emotion.

    11. BE

      Yeah.

    12. EP

      For kids who struggle with binge eating and purging behaviors, they also tend to also struggle with self-harm behaviors. When they feel that really big emotion, making themselves vomit numbs them out instantly. It just brings them from a 10 out of 10 to a zero. Now, usually shame comes after that, and then they're back on the wheel of having really high emotions. Um, but really reminding parents that these are serving a purpose and not to vilify them. Um, even in the eating disorder community, people are like, "Well, I have anorexia. That's the good eating disorder," whereas, y- you know-

    13. BE

      Mm

    14. EP

      ... bulimia, making yourself vomit, is the bad eating disorder.

    15. BE

      Mm.

    16. EP

      That is not true. And I tell parents, "If you think your kid is vomiting, they are. By the time you think that they are, they are," 'cause eating disorders are so secretive, but don't freak out. Don't act as though that's the worst thing your kid could ever do. They, there are no worst eating disorder behaviors, and they're serving a purpose for them.

    17. BE

      Mm.

    18. EP

      So give them an opportunity to share with you when it's coming up, and let's help them to not give in on that urge.

    19. BE

      Yeah, a- and just as a metaphor there, like, I think about how many of us, I don't know, we scroll on our phone at night even though obviously we know that's not a good idea, or we're saying we're gonna go to the gym in the morning but we snooze and we're like, "Well, I didn't do that," even though we know it would've made us feel better. And, you know, approaching that, if someone came to us and is like, "Why you, why you on your phone? You know not to be on your phone. Why are you snoozing?" Like, "Obviously, go to the gym," I don't know anyone who's like, "That is, that is so helpful. I'm now gonna change my behavior." [laughs] Like, thank you. No, right? Um, and actually what helps us change the behavior, because also so many of us can be self-critical, right, is, okay, being on my phone at night must do something for me. What is that? Right? That's the start of, well, could I get that from somewhere else, or what am I looking for? Snoozing in the morning, like, what's going on there? Beyond maybe being tired, is it, do I feel bad about my body when I go to the gym and I kinda want to avoid that feeling? Like, we also regulate our emotions through maladaptive behaviors, right? And that cur- it's a practice to be curious, and I think what you're saying with restricting, binging, purging, on the surface if we meet it with, "Why are you doing that? That doesn't make sense," we're actually not getting to the source. Like, what is this doing for my kid? Doesn't make you permissive. It actually makes you able to start figuring it out.

    20. EP

      And how can you help do that for them until they have the skills to do it?

  11. 21:39 – 23:07

    Family-based treatment: parents ‘pilot the plane’ and take charge of meals

    1. BE

      Oh, say more.

    2. EP

      It goes back to kinda what you were saying about control. Um, people think-

    3. BE

      Mm-hmm

    4. EP

      ... I am going to get control of my thoughts by controlling my food.

    5. BE

      Mm.

    6. EP

      All I think about is my body. All I think about is food. You know what? I'm gonna start controlling exactly what I eat, and that will make my thoughts go away. That is the, the lie of eating disorders because it just makes it worse and worse and worse, and soon you're... You know, I had a mom call me once, and her child is 15, had just gotten back from residential. She's like, "Erin," she is sobbing 'cause she can't figure out if it's 15 blueberries or a third a cup of blueberries, 'cause apparently 16 fit in there and she doesn't know what she should eat.

    7. BE

      Mm.

    8. EP

      And [clears throat] that's an example of the eating disorder is actually in control. And so what parents do to help their child recover from an eating disorder is the parents take control of eating.

    9. BE

      Yeah.

    10. EP

      "You don't have to think about this anymore. I'm going to tell you what you're eating for breakfast, for lunch, for dinner. You don't have to like it. You do not have to compliment me, and you are even allowed to swear during it. I'm going to sit next to you and provide comfort while you do this hard thing. And you've been using restricting to help regulate your emotions. I'm gonna help you regulate them in a different way until you have those skills."

    11. BE

      Yep. I, I kind of, and I, this is always my favorite metaphor, but, oh, you're actually showing me you can't be the pilot of your food plane anymore.

    12. EP

      I love that.

    13. BE

      Right? Is that what it is?

    14. EP

      Yes. I, I absolutely love that.

    15. BE

      And, and it's not because you're a bad person-

    16. EP

      Right

    17. BE

      ... and it's not because you won't be able to again, but I can see that, and so I'm, I'm stepping in because I love you and I want to keep you safe, and I'm gonna pilot this until you can take the reins again.

  12. 23:07 – 28:26

    Teens resist—because they’re protecting you: why earlier involvement helps

    1. EP

      I absolutely love that, and I- I'm gonna use that because most parents call me and they say, "I need to not be involved in their treatment, uh, because I will make it worse, because my teen tells me they don't want me there. Because this is about control, so I should give them the control to get through their eating disorder." And I remind them, "Your kiddo can't do this."

    2. BE

      Yeah.

    3. EP

      Like, if your child was struggling with substance use, you wouldn't sit and wait for them to take the alcohol out of the house. You would go and get all the alcohol out of the house.

    4. BE

      I'm gonna write that one down.

    5. EP

      Yes.

    6. BE

      Yeah, exactly. [laughs]

    7. EP

      [laughs] Um, and we talked to, um, 50 different teenagers who started our family-based program, and zero of them wanted their parents involved, which is totally normal. And I said to their parents, I'm like, "You should be happy. That is a developmentally appropriate-

    8. BE

      Yes

    9. EP

      ... response." But when I ask the parents, "Why do you think your teen doesn't want you involved?" the parents are like, "They think I'm gonna make it worse. They think I don't know what I'm doing."

    10. BE

      Yeah.

    11. EP

      "They hate me." Oh, I get emotional here.

    12. BE

      Mm.

    13. EP

      When I ask the teens, "Why you don't want your parents involved?" they say, "I don't want them to know how bad it is, and I don't want them to worry." And when parents know that, they're like, "Get out of the way. I'm coming in." At the end of the study, all of them except one were so glad their parents were involved, and they also said, "I wish they'd gotten involved earlier."

    14. BE

      Ugh, Erin. Mm.

    15. EP

      And it was incredible because every parent was thinking, "Am I making a mountain out of a molehill? Is this just a phase? Am I making it worse by getting, um, worried or bringing them in to see you?" And in the end, every kid said, "I needed my parents sooner."

    16. BE

      Uh, uh, you know, I think a lot about being longterm greedy as a parent, and not maximizing or optimizing for immediate ease or happiness, right? But as a parent, like, I'm, I'm thinking about who my kid's gonna be five months from now, five years from now, 15 years from now. And I think with this type of treatment, it's, it's, it's short-term thinking, which we all have. They're gonna be mad at me. Okay, longterm greed would actually say, "Hold on. I wanna maximize my kid's emotional health, physical health. I'm willing to put up with..." Yeah, they might be short-term pissed, but, like, I, I love my kid in this longterm way, and I wanna set them up, and that can maybe help push past a little bit.

    17. EP

      Yes. Families talk about being stronger also when they get through treatment.

    18. BE

      Uh-huh.

    19. EP

      And the parents also say, they're like, "I am so much [laughs] more emotionally regulated than I was before." It, it does take something special to tolerate your kids not liking you, especially when it's multiple days and weeks and months in a row sometimes, as, as eating disorder treatment can be. Um, but the- I love that, the longterm greedy. The reward is there. You both get a healthy kid-

    20. BE

      Mm

    21. EP

      ... but you also have a kid that is so grateful that-

    22. BE

      Yes

    23. EP

      ... you helped them get well.

    24. BE

      Yes. You know, [laughs] one of my... When my kids were younger, one of the things I would say around our own screen time rules or bedtime rules, but it's kind of the same thing, is like, "My number one job is to keep you safe, and also, it's to kind of make decisions that I believe are good for you longterm, even if you're pissed at me in the moment. And I'm just gonna say this. I love you enough to make those types of decisions, and this is one of those moments." And I, I kind of felt like a badass every time I was saying. Like, I'd have to, like, work myself up, but then I heard myself say it. And by the way, just to be clear, it wasn't [laughs] like the kids were like, "That was, that was really an A+ mom."

    25. EP

      [laughs]

    26. BE

      No. They, they then do the thing. They're like, "You're annoying. All my friends," whatever.

    27. EP

      Mm-hmm.

    28. BE

      But if you kind of set yourself up instead of in an apologetic way, in this, like, bold way, I, I feel like I was then ready. I was like, "Okay, so I said my part. You're gonna do your part. You're gonna complain short term. Everything's going according to plan, um, and we're just gonna, you know, keep walking down that path." I think one of the most memorable moments of my private practice, I, I can picture her in this moment exactly, is this... A- and it's not eating disorder related, but I, but I think there's such a parallel. I don't know. She's 15 or 16 then. She came af- she was cutting, got referred, and I asked her first session, "How long has this been happening?" "Two years." I was the first therapist she saw. And I said to her, "Okay, well, your parents, you told me, also have known. Like, how come you didn't see a therapist? Just curious, you know, me or anyone?" She's like, "Oh, well, I told my parents..." She was so snarky. "I told my parents. Oh, so you think I'm fucked up? I'm the messed up one in the family, and I'm just gonna go and lie or not talk, and I'm gonna waste all your money." And, and Erin, my heart always races when I... okay [laughs] because same thing, I think. She then just got silent, and, like, her whole demeanor changed, and she looked up at me after, like, a minute. And I just kind of, for some reason, knew to, like, shut my mouth. She's like, "Can you believe they let me make that decision?"

    29. EP

      Yeah.

    30. BE

      It was from this, like, snarky teen to this, I'm also crying, like, this really young, like... And can you belie- believe they let me pilot the plane when I was showing in clear as day sign that I couldn't do it, and my rude words were enough for them to take [laughs] their hands off the wheel? Like, and, and I, I always think about that because I think we take... I respect kids deeply, but we take their snark, like, way too seriously. And under it is so often such desperation and shame and fear. And, and by the way, I don't think it's teen. Like, we're... I- in our worst moments, we just want someone to kind of say, "I'm not taking this at face value because I love the heck out of you, and, and you need a different level of help."

  13. 28:26 – 31:08

    Practical parent problem-solving: using what you know about your child to support eating

    1. EP

      My favorite, to, to, to go to a hopeful story and why I'm just always like, "Parents, be involved, be involved, be involved, be involved." Like, don't think that your absence is what your kid needs. It's, it's your presence. Um, there was a child who was trying to weight restore, and she needed to have about 3,500 calories a day to weight restore, which is pretty normal. If you don't have an eating disorder, you only need a couple extra hundred calories a day, but if you do, you become hypermetabolic, and you need to eat a lot. And they could not figure out how to get enough calories in her, and so she had been the same weight for, I don't know, eight weeks. And the mom and dad were just kind of scratching their heads. And one day, the dad came into my office. He's like, "I figured it out." He was so triumphant. And he realized, um, we'd been talking about the neurobiology of eating disorders and how consequences are more salient than rewards when someone struggles with anorexia. And that's why we play through the pain. That's why we stay up studying, because we gotta get that A. And he's like, "I figured it out. You know what's a big consequence? Is when she shows up late for school, and everyone in first period turns and looks at her when she comes in." He's like, "So I started making this high-caloric shake." It was like an 800-calorie smoothie. And then he's like, "I drove her to school every single day. And this, of the week." And he's like, "I'd say to her, 'Hey, listen, I don't have any meetings until 9:45, so I can stay in the car with you as long as it takes to finish your smoothie. I talked to the school counselor. You can walk into first period late.'" Finished that smoothie in seven minutes every single day.

    2. BE

      Yeah.

    3. EP

      Never got late to first period.

    4. BE

      Oh.

    5. EP

      But what was great about it is I didn't give them that idea, 'cause I don't know their child as well as-

    6. BE

      They know

    7. EP

      ... they know their child.

    8. BE

      No.

    9. EP

      And so empowering parents to be, remember that they are this child's parent. They are the one that can help them get better.

    10. BE

      Go back to what you're saying about cancer. Like, I don't know any parent who's like, "My kid doesn't want chemo, so... But they're 16, and one day they're gonna have to figure it out by themselves, and so I'm gonna let them make this decision." Like, I've never heard that.

    11. EP

      Never.

    12. BE

      Never.

    13. EP

      Never.

    14. BE

      Right? [laughs]

    15. EP

      Yes. Yeah.

    16. BE

      We are kind of talking about, and I know we think a lot about Good Inside about boundaries as part of our role. And I think the big difference, and it's so many of us experience this so differently that we have to reformulate it in our head, is that these type of boundaries and assertion of w- what I think is parental authority without aggression is not something you do to your kid. It's something you do for your kid. And I think your whole model of eating disorder treatment is it's, it's something you're doing for- Your kid.

    17. EP

      You do it for them and you do it with them-

    18. BE

      Yes

    19. EP

      ... and you go through it together. Uh, you know, I talk with families, um, when your kid is in crisis, whether it's depression or an eating disorder or self-harm, I'm like, "Choose two things." Like, I don't wanna hear about their grades improving or they're not swearing in front of-

    20. BE

      Oh

    21. EP

      ... their little brother or-

    22. BE

      Yes

    23. EP

      ... right? And one of the first things that goes is the no phones at the dinner table rule, and I'm like, if they need to, I don't know, watch Gilmore Girls on their phone in order to distract themselves to eat the meal, then that's what they should do, and you're gonna do it with them. You're gonna figure it out. You're gonna sit and watch the show with them.

    24. BE

      Yep.

    25. EP

      Get engrossed in something.

  14. 31:08 – 41:58

    If you feel you missed the signs: self-compassion, repair, and body-talk that helps

    1. BE

      Yep. Now let me ask you, you know, we focus a lot on repair at Good Inside. For the parent listening who's thinking, "Shoot. Shoot, I've missed it," what do you, what do you wanna say to them, or where do they start?

    2. EP

      So first be so, so kind to yourself, because you have been raised in this culture, this culture that... Well, also if you're a parent, you are, after having dealt with the be smaller, you know, look different, um, meet America's ideals of beauty, you're now also hitting the don't age, don't age, don't age, something that there's nothing we can do about that. [laughs] Um-

    3. BE

      We can't live forever.

    4. EP

      We can't live forever.

    5. BE

      No.

    6. EP

      Yeah. Um, so just be kind to yourself, and calling it out is the best thing that you can do for your whole family, and again and again and again and again. You can say, "Oh, you know, when I had that ice cream last night with you, I noticed my old thoughts of feeling bad about it come up." Um, I mean, I'll give an example with actually my nine... When my son was nine, my eldest son was nine, this story just gets me still, um, he came home and actually we were getting ready for bed, so he was, like, in his underwear. This is still the days when the underwear was, like, colorful or had characters on it. They're so old now, the kids.

    7. BE

      Mm-hmm.

    8. EP

      But when he was nine and he grabbed his belly and said, "I wanna get rid of this. I heard that cold showers would help." And the first emotion I felt was anger. I'm like, "How did this get in my house?"

    9. BE

      Yeah.

    10. EP

      Right? He's a nine-year-old boy being raised by a parent who specializes in eating disorders. And so I want all parents to know that even someone who's worked so hard for all foods fit, the kids see me eat all different foods, it, it's going to get there because the culture, the society, their peers-

    11. BE

      Yeah

    12. EP

      ... it is everywhere.

    13. BE

      Yeah.

    14. EP

      So, so don't, don't get too mad at yourself, and you have this incredible ability to model that all foods fit, that you can change your behaviors, that just 'cause you did something once doesn't mean you have to do it again.

    15. BE

      Yeah. You know, someone said to me, it, it's like a f- proverb, I can't remember who originally said it, but, like, "The best time to plant a tree is 20 years ago, and the second-best time is right now." You know, the other thing I just wanna give parents listening who feel like it's too late is I feel like when we're in it's too late mode, we're doing the thing we all do. We look back and we think about all, "Oh, I c- I could've done that," and, "That was a sign," and, "I didn't pay attention to that in the way I wish I did," and we all do that, and I, I don't think we can take that away, but what we don't add, I think, is this gaze forward, where we're like, "Okay, my kid is 13," "My kid is 23," what, however old they are. There's actually so many more years ahead than behind, and that's not to convince myself out of my guilt, but just to add, okay, like, I'm actually a lot earlier today than I am 10 years from now, than I am... And, and there's, I think there's, like, hope and, like, a balance to that too.

    16. EP

      Yeah. My mom still wants me to be happy today just like she did when I was 14. My mom still wants me to enjoy my life today, and so that'll be true too. And, um, that story with Max, like, what I-

    17. BE

      Mm

    18. EP

      ... I had to tell my anger to move to the side for a second.

    19. BE

      Yeah.

    20. EP

      But it was an opportunity for me to say to him, "Hey, did someone say something to you about your belly, or is it something that you say to yourself?" And he's like, "Oh, I say to myself." And I got to say, I'm like, "You know, my brain says a lot of bad things about my body to me sometimes too."

    21. BE

      Oh.

    22. EP

      He's like, "Really?" And I'm like, "Yeah," and then we talked about, like, how do we talk back to our brain when our brain's kind of a jerk. Um, so it's, it's the same skills we use for other things, but it was really, um, an opportunity to remind our kids that this is a human condition.

    23. BE

      Yes.

    24. EP

      I think a lot of parents are tempted, as I am, um, to say, "What? No, you're not fat," or, "You're beautiful," and instantly correct their thought for them, um, which, as you said, doesn't work, but additionally it then signals that there's a right and wrong. There are kids that come in all shapes and sizes and might grow up to be an adult of all shapes and sizes.

    25. BE

      Yes.

    26. EP

      Um, I remind my children that it would be nuts to be like, "Let's change your shoe size."

    27. BE

      Mm.

    28. EP

      No one's trying to change their shoe size. They, then they're like, "This is a s- uh, Mom, what are you getting at?" Right? They get very annoyed.

    29. BE

      Yeah.

    30. EP

      But, um, and yet we try to change everything else, our hair-

Episode duration: 41:58

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