October 12, 2025 • 29 mins
10/12/25
The Healthy Matters Podcast
S05_E01 - Food, Feelings, and Freedom from Eating Disorders
With Special Guest: Dr. Melissa Eisenmenger, PhD, LP
Binge eating disorder, Bulimia nervosa, Anorexia nervosa - there’s a chance you’ve heard of these, but do you really know what they are?
Eating disorders are complex and affect both our physical and mental health, and unfortunately, the number of reported cases has doubled since the year 2000(!!). Obviously, food is an essential part of our lives and something many of us find great joy in, but for others, the relationship is much more complicated, oftentimes leading to dangerous outcomes. But who gets eating disorders? How and when do they develop? And what can be done to identify, diagnose, and get help to those who need it?
Social media, diet advertisements, and diet culture are big contributors, but they’re not the only culprits. On Episode 1 of Season 5, we’ll sit down with Dr. Melissa Eisenmenger (PhD, LP), a psychologist at Hennepin Healthcare who’s helped countless people who suffer from eating disorders. We’ll have an open and honest conversation around the causes, diagnoses, and treatments of these all too common conditions, as well as discuss ways you can support anyone you know who might be affected by them. We hope you’ll join us.
The National Eating Disorders Association (NEDA) website is an excellent source of information and resources for anyone seeking help.
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey, hey, everybody, and welcome to the first episode
of season five of the HealthyMatters Podcast.
I am your host, David Hilden.
I am so glad you've stuck withus through four incredible
seasons of the show.
Thank you to everybody forlistening, and thank you to my
numerous guests from HennepinHealthcare and beyond.
Today, we're going to talk abouteating disorders.
(00:41):
You know food is supposed tobring us comfort in life and
nourishment from grandma'sfamous chocolate chip cookies to
a late-night pizza run.
However, for many people, foodcan also be a source of fear,
anxiety, and serious illness.
Eating disorders affect nearly30 million people in the United
States alone, and nearly 15% ofall women will experience one in
(01:02):
their lifetime.
But what makes these conditionsso common?
To help us unpack all of this isDr.
Melissa Eisenmenger.
She is a clinical psychologistand someone who knows this topic
inside and out.
Dr.
Eisenmenger, thanks for beinghere.
SPEAKER_02 (01:14):
Thank you for having me.
SPEAKER_03 (01:15):
Could you start with some of the basics about eating
disorders?
What are they?
Or you know, just define it forus if you could.
SPEAKER_02 (01:22):
Sure.
So eating disorders broadly arecomplex and serious conditions
that not only affect mentalhealth but also physical health.
And we can see disturbances inthings like thoughts, behaviors,
and emotions as they relate tofood, eating, and one's
relationship to food.
And also disturbances in the waythat people see themselves in
(01:45):
terms of their body weight,shape, and size.
And these disturbances causequite a bit of distress for
people, an impairment infunctioning.
I'd like to point out that a keydifference between disordered
eating and an eating disorder isnot only in the frequency and
intensity of the symptoms inbehaviors, but also in how much
(02:05):
food tends to dominate, disrupt,and really permeate lots of
different areas of a person'slife.
SPEAKER_03 (02:12):
I had heard the word eating disorders decades ago,
although I do have to admit, notmuch in medical school.
But I had not heard the termdisordered eating to maybe the
last decade.
Could you tell us a little bitmore about that?
So is disordered eating just anadjective for people who have a
troubled relationship with food,or is that a diagnosis?
SPEAKER_02 (02:33):
So disordered eating is not a diagnosis, and it is
more when clinicians seesomething like maladaptive
eating patterns.
I have some examples of thatthat are pretty specific, like
something called orthorexia, forexample.
I don't know if you've heardthat.
SPEAKER_03 (02:49):
No, but what's orthorexia?
SPEAKER_02 (02:50):
Yeah, so orthorexia, the term has been around for 25
to 30 years, but it's coming tomore of the attention of medical
professionals and dietitians.
And orthorexia is when somebodybecomes really fixated on a
circumscribed diet and theymight have really very rigid
rules around what can be eatenor when things can be eaten.
(03:13):
And there are lots of differentexamples of orthorexia, but
orthorexia is one example ofsomething that we can see either
coming into or going out of aneating disorder.
And so that might be, again, oneexample of that maladaptive or
disordered eating.
SPEAKER_03 (03:28):
Is that always a bad thing?
Is it always a disorder leadingto a full-blown eating disorder?
Or is that just is it all youknow what I'm getting at?
Is it always a bad thing?
SPEAKER_02 (03:40):
Aaron Powell So it's more of a matter of degree.
And again, I would say how muchum a pattern of disordered
eating is disrupting a person'slife and causing that distress
and impairment in their lives.
SPEAKER_03 (03:52):
Aaron Powell We're gonna talk about specific
diagnosable eating disorders alittle bit in the show, but
could you just kind of give usum uh why do people get these?
What are there risk factors fordeveloping eating disorders?
SPEAKER_02 (04:03):
Yeah, there are lots of different risk factors, and
it's probably a combination ofthose risk factors that
contribute to somebodydeveloping an eating disorder.
So some of the differentcategories can include things
like psychological factors.
So things like depression,anxiety, trauma, post-traumatic
stress disorder, difficultieswith coping, having a lot of
(04:26):
stress and few coping skills canbe things that predispose
somebody to developing an eatingdisorder.
The other thing is environmentalfactors.
So things like bullying,pressures from family or friends
or peers to lose weight,certainly social media, diet
culture.
Another element can betemperament.
(04:46):
So specifically, we know thatthings like perfectionism can
contribute to the development ofan eating disorder.
And then finally, there aregenetic and biological factors
that can also contribute.
SPEAKER_03 (04:56):
So lots of different risk factors.
Right.
At the beginning in my intro, Imentioned some pretty staggering
statistics that a lot of peoplehave eating disorders or have
experienced them at some pointin their life.
Why are those numbers so high?
And the follow-up to that is isit going up?
Is it down?
Is it stable?
SPEAKER_02 (05:12):
Yeah, so those numbers are really high.
And again, in part, there'sprobably no one reason.
Social media and again, diet anddiet culture really probably
contribute to those highnumbers, as well as things like
social pressure to achieve thissort of thin ideal.
SPEAKER_03 (05:29):
Why are women affected more than men?
But men are as well.
I think we've got to be clearabout that, right?
SPEAKER_02 (05:34):
Yes, so absolutely.
So women do tend to be affectedmore than men, and that can also
be for a variety of reasons.
So biologically, women might bemore predisposed because of
things like hormones and brainchemicals called
neurotransmitters.
There might be socioculturalinfluences.
So again, I'm thinking aboutsocial media, how diet
(05:56):
advertisements tend to targetwomen.
Women feel more pressure to bethin.
There are a lot of things outthere on social media that again
target women and sometimes evenmake it seem very easy to lose
weight or to go on one of thesefad diets.
There might also be a bit ofdiagnostic bias.
Eating disorders are primarilyseen as a women's problem.
(06:20):
And so that might mean that formen, it goes unrecognized,
underdiagnosed, andundertreated.
And then finally, if we thinkabout mental health conditions
such as depression and anxietybeing comorbid with eating
disorders, we know that thosemental health conditions also
affect women more than theyaffect men.
SPEAKER_03 (06:40):
So why are they on the rise?
SPEAKER_02 (06:41):
An interesting fact is that eating disorders doubled
between 2000 and 2020.
So the rate doubled.
SPEAKER_03 (06:48):
It's gotta be social media.
SPEAKER_02 (06:50):
Absolutely.
So a large factor here is socialmedia.
SPEAKER_03 (06:53):
Well, that's staggering.
SPEAKER_02 (06:54):
Yes, it is.
SPEAKER_03 (06:55):
Doubled in the last 20, 25 years, and it's roughly
the same time as social media.
SPEAKER_02 (06:59):
Yes, absolutely.
SPEAKER_03 (07:00):
I want to delve into that a little bit more.
Is that an intentional thing?
Or is this, I mean, are thereorganizations or companies that
are just marketing, or is thislike an amplification of what
used to happen in the middleschool lunchroom and the
pressures there?
Now it's just more amplified.
Do you get what I'm saying?
SPEAKER_02 (07:17):
I do maybe more so the latter.
And so you're right in thateating disorders existed before
social media.
Now there are a lot of forumsthat people can go on in social
media targeting different, youknow, fad diets again and
different ways of eating,different ways to lose weight.
Social media influencers mightcontribute a great deal to how
(07:38):
people believe that they shouldlook or kind of a stigma even
against obesity or beingoverweight.
Another thing that hascontributed to the rise, really
interesting though, is with theonset of the pandemic, the
COVID-19 pandemic.
And so I know that the NationalEating Disorders Association saw
a pretty drastic rise in callsto their helpline between 2019
(08:00):
and 2020, in the same months in2019 and 2020.
And so, you know, the pandemicled to people being much more
isolated, having meals sociallya lot less often, being more
sedentary, having constantaccess to food, and kind of
being out of a normal day-to-dayroutine.
SPEAKER_03 (08:19):
And sitting on their screens.
SPEAKER_02 (08:20):
Absolutely.
Yeah.
Absolutely.
SPEAKER_03 (08:22):
Yeah.
So many people think that eatingdisorders are all about maybe
vanity or I'm just dieting, I'mdieting, and it just went a
little bit too far.
It's a little bit more thanthat, I think, um, probably.
Is can you briefly address thatnotion?
SPEAKER_02 (08:37):
Absolutely.
So first let me address thepiece about vanity.
So it can be sort of a damagingoversimplification to think that
eating disorders are because ofvanity.
Most of the time, eatingdisorders start out as a
protective function for theperson.
It gives the person a sense ofstructure.
(08:58):
It gives the person a way tocope with internal or external
chaos.
It gives the person a way tocope with stress or emotion
dysregulation.
As an eating disorder takeshold, what can happen is that
then we start to develop theseideas about what our bodies
should look like.
And that tends to fuel then moredisordered eating.
SPEAKER_03 (09:19):
Let's shift and talk about the various types of
eating disorders.
Could you talk us through whatthe big ones are?
SPEAKER_02 (09:25):
Sure.
So binge eating disorder entailseating binges, of course.
And so eating binges have twodifferent sort of criteria that
we look for.
One is eating a very largequantity of food in a discrete
period of time, usually twohours or less.
And this would be an amount offood that would go above and
beyond what most people wouldeat in a similar period of time.
(09:47):
And the second thing for aneating binge would be a loss of
a sense of control over one'seating.
And this is really a hallmark ofan eating binge, and it
distinguishes overeating from aneating binge.
SPEAKER_03 (10:00):
That you simply can't stop?
SPEAKER_02 (10:02):
Right.
So some people say that theycan't stop.
Some people say that theystarted out intending to eat a
certain amount, and then beforethey knew it, they were getting,
you know, a third or fourthhelping or ordering more food.
It can be an urge that peoplehave to continue eating, even
though they feel veryuncomfortably full.
So for binge eating disorder,the binges are one piece of it.
(10:25):
But then there are also thingslike, again, eating until
feeling uncomfortably full.
Eating large amounts of food, itcan be a lot of distress,
feelings of guilt and anger andfrustration and disgust around
an eating binge, eating rapidly,or eating alone because you're
embarrassed about eating.
SPEAKER_03 (10:44):
Is that the same as bulimia nervosa?
SPEAKER_02 (10:47):
So it's not.
That's a really good question.
So bulimia in bulimia nervosa,there are eating binges.
So that eating a very largequantity of food and a loss of a
sense of control over one'seating.
But then there are alsocompensatory behaviors that a
person intends to kind ofcorrect for the overeating or
(11:08):
binge eating and are also meantto prevent weight gain.
So when I say compensatorybehaviors, what I mean by that
are purging by vomiting.
It could be use of laxatives oruse of diuretics.
It can be excessive fasting orrestriction, or it could also be
excessive exercise.
SPEAKER_03 (11:28):
Who uh is most at risk for those two?
The binge eating disorder andthe bulimia nervosa.
SPEAKER_02 (11:35):
So those two are a little bit different in terms of
who's at most risk.
Um, for binge eating disorder,we really see more of kind of
broad brushstrokes over who isaffected by that.
It can be people of normalweight, it can be people who are
obese, it can be people who areunderweight, you know, eating
disorders in general.
There's some research to suggestthat it affects different racial
(11:59):
and ethnic groups prettysimilarly for those living in
the United States.
For binge eating disorder inparticular, it tends to affect
women just as much as it affectsmen.
For something like bulimia, onthe other hand, it's much more
common in women, probably threeto four times more common in
women than in men.
SPEAKER_03 (12:19):
So that compensatory mechanism, is that largely to
maintain a weight, to not gainweight?
Is that largely why?
SPEAKER_02 (12:26):
It is, although it doesn't always end up in reduced
weight or people beingunderweight.
Um sometimes people with bulimiaare of normal weight or are
overweight.
SPEAKER_03 (12:35):
Okay, turn to anorexia nervosa, if you could,
please.
SPEAKER_02 (12:39):
So anorexia nervosa is defined by restriction of
calories or energy intake inrelation to what one really
needs to maintain a healthyweight, and so people can become
very underweight.
There's an intense fear ofgaining weight or becoming fat.
(13:00):
And there can be distortedperceptions on what one's body
looks like.
There can be lack of insight asto how serious the disorder has
become, and there can be a senseof self-worth that is unduly
influenced by one's body weight,shape, or size.
SPEAKER_03 (13:18):
Aaron Powell Is this one mostly in girls and women?
SPEAKER_02 (13:21):
It is, again, about three to four times more likely
to affect girls and women.
SPEAKER_03 (13:26):
Aaron Powell So those differences in males and
females.
Could you comment a little bitabout the effect on the
transgender community?
SPEAKER_02 (13:32):
Absolutely.
So we know that transgender andnon-binary individuals have
higher rates of all of thoseeating disorders that I just
mentioned in relation to theircisgender counterparts.
SPEAKER_03 (13:43):
Aaron Powell When do these typically develop?
I know there we've just talkedabout three separate diagnosed
eating disorders, but when dothey typically develop?
SPEAKER_02 (13:52):
That is stratified based on the eating disorder
itself.
So for something like anorexianervosa, we tend to see the
development between roughly agesof 12 and 15, sometimes
coinciding with the onset ofpuberty.
For something like bulimianervosa, the median age of
developing something like thatwould be closer to 18 or 19
(14:14):
years old.
And then for binge eatingdisorder, it tends to be a
little bit later, so around age21.
Although it should be said thatall of these things can be
diagnosed much later in life.
SPEAKER_03 (14:24):
We're gonna talk much more about what it's like
to diagnose, treat, and getsupport for all of these after
the break.
We have been talking to MelissaEisenmanger.
She is a doctor of psychologyand a colleague of mine here at
Hennepin Healthcare in downtownMinneapolis.
We're talking about eatingdisorders.
We are gonna take a short break,and I hope you'll join us when
we come right back.
SPEAKER_00 (14:47):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(15:09):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (15:24):
And we're back talking with Dr.
Melissa Eisenmenger.
She is a psychologist and we aretalking about eating disorders.
So, how are they typicallydiagnosed?
SPEAKER_02 (15:33):
Yeah, so eating disorders in particular can be
really challenging to diagnose,in part because people tend to
be relatively secretive aboutthe disorder, because again, we
need to think about thatprotective function that they
serve for people.
So, unlike things like medicalconditions or even some other
mental health conditions, peopledon't necessarily want to be
(15:57):
treated for their eatingdisorder because it is serving
that function.
And so sometimes it does comeacross in a medical visit for
people when there's somethingthat is noticed in terms of a
drastic weight change orsomething that might come up on
abnormal blood work.
It might be something that'snoticed by family or friends
that's brought to somebody'sattention.
(16:18):
But again, these can be reallychallenging to identify and to
get people to talk about.
SPEAKER_03 (16:23):
Who typically diagnoses them?
SPEAKER_02 (16:26):
So mental health professionals can diagnose
eating disorders, and that wouldbe based on the criteria that we
talked about for each of thoseeating disorders.
SPEAKER_03 (16:34):
Is it true that the diagnosis is sometimes delayed
because it because of whatyou've just said, people are a
little bit more secretive aboutit.
Maybe they don't have a mentalhealth professional, maybe they
have a pediatrician, maybe theyhave a family doctor, a general
internist like me.
SPEAKER_02 (16:48):
Yeah.
And so you're right about thedelay and diagnosis.
And we also know that the longerdiagnosis is delayed, the longer
treatment is delayed.
And so these eating disorderscan become more dangerous over
time for a variety of reasons.
But yeah, absolutely.
Probably primary care officesare maybe kind of the first line
(17:08):
of identification and gettingsomebody into treatment for
eating disorders.
SPEAKER_03 (17:13):
What are some of the common treatment approaches?
SPEAKER_02 (17:16):
That's a really good question.
So for something like bulimiaand binge eating disorder, CBT
or cognitive behavioral therapyhas been shown to be effective.
And cognitive behavioral therapyrevolves around the idea that
our thoughts, emotions, andbehaviors are all linked.
And so CBT for something like aneating disorder would focus on
(17:40):
thoughts that perpetuate andmaintain an eating disorder.
For example, there's an enhancedform of cognitive behavioral
therapy for eating disorders,which has a little bit more
psychoeducation specific toeating disorders.
SPEAKER_03 (17:53):
Where do people find a professional that is skilled
in CBT?
SPEAKER_02 (17:56):
Yeah.
So if I see somebody in need oftreatment for an eating
disorder, what I usually do isrefer to somebody who has a
specialty in eating disorder oran eating disorder program like
the ones that we have here, someof the programs that we have
here in the Twin Cities.
SPEAKER_03 (18:12):
Say more about those if you could.
Are those outside of yourpsychologist, your primary
doctor, there are specialtyprograms.
And in the Twin Cities, we havesome of them.
I'm sure if you are listening tothis in California, New York, or
Texas, you probably have them aswell.
What are those programs like?
What happens there?
SPEAKER_02 (18:30):
So usually programs, people get treatment based on
how severe their eating disordermight be.
And so it might be a combinationof individual and group
therapies on an outpatientbasis.
It might be residentialtreatment, but uh a combination
of individual and group therapyis usually what is offered and
what is best.
SPEAKER_03 (18:50):
Is there a role for medication?
SPEAKER_02 (18:53):
So I'm not a prescriber, so I don't want to
speak too much about themedications.
What I would say that I consideris having somebody that is
hooked in with a prescriber whois familiar and has expertise in
working with eating disorders.
You know, I believe that some ofthe medications that are
(19:14):
prescribed for things likedepression and anxiety, which
can be comorbid with an eatingdisorder, are actually
contraindicated for some peoplewith anorexia and bulimia.
So I don't want to speak toomuch to the specifics of what
those medications are.
It's not necessarily mywheelhouse.
SPEAKER_03 (19:32):
That's a good approach.
I do prescribe medications everyday in my life as a primary care
doctor, and I wouldn't do thisonce without someone's
expertise.
I think that that's a reallygood point to note to if you, a
loved one, or you are wonderingif you have an eating disorder
or you've been diagnosed withone, the right treatment
approach is not to rely on yourprimary care doctor to give you
(19:54):
something in a pill bottle.
What you said at the beginningis far more important.
Cognitive behavioral therapy,get the right supports that you
need in or outside of a program,but you need somebody who knows
this field very specifically.
What about nutritionalcounseling?
Does that happen in I I assumeit happens in treatment centers.
Is that a good route to go?
SPEAKER_02 (20:15):
Yeah, absolutely.
So treatment centers usuallyhave dietitians on board again
who are familiar with, havespecialty in eating disorders.
So nutritional nutritionalcounseling is incredibly
important, whether we're talkingabout binge eating disorder,
anorexia nervosa, or bulimianervosa.
Some programs I believe alsoincorporate physical therapists
(20:36):
to help people get a healthysense of, you know, movement and
what healthy exercise lookslike.
SPEAKER_03 (20:42):
I'm gonna move to it to something a little bit maybe
harder to hear.
What are some of theconsequences that you see of
untreated eating disorders?
It can be serious, right?
SPEAKER_02 (20:53):
It absolutely can.
And as I mentioned earlier, thelonger an eating disorder goes
untreated, sometimes the moredangerous they become.
For anorexia nervosaspecifically, it's the mental
health disorder with the highestrate of mortality.
And so that that mortality riskincreases as the years go by.
(21:16):
Risk of malnutrition withsomething like anorexia or
bulimia nervosa, an electrolyteimbalance, especially again as
these things kind of proceedover the longer term.
For something like binge eatingdisorder, if that is leading to
overweight or obesity, that canalso have or end up leading to
health complications.
SPEAKER_03 (21:36):
So true physical uh uh health complications.
And some of them, I r I rememberwhen I was a child, the most
famous one uh of all, um thewoman with the most beautiful
voice you've ever heard in yourlife, Karen Carpenter, was on
the front page of a newsNewsweek or something.
None of us had heard of it.
And she had died of anorexianervosa.
(21:56):
And and that was what it openedum many of our eyes.
I was just a kid, uh um, but Iremember it um kind of rather
vividly.
So there are some seriousconsequences.
Could you talk about emotionalconsequences, not only to the
person who has the eatingdisorder, but to their family
and in their relationships?
SPEAKER_02 (22:15):
Sure.
So again, um, comorbiddepression and anxiety, as well
as trauma and post-traumaticstress disorder, can affect
people with eating disorders.
People with eating disorderssometimes feel a lot of shame or
guilt over what is happening.
And so that is also what canprevent people from getting the
(22:37):
treatment in a timely manner.
On families, you know, it can befeelings of guilt, certainly
fear, helplessness, not knowinghow to approach a loved one that
they might suspect has an eatingdisorder.
There can be feelings of blametoward oneself or toward the
person with an eating disorder.
(22:58):
Sometimes that can lead tofamily discord.
And we know that the more kindof dysfunctional a family unit
or the more discord there is ina family, sometimes that can be
associated with more eatingdisorder symptoms.
SPEAKER_03 (23:12):
Could you give us advice on when a parent or a
partner or a good friend or thea person, him or herself, their
self, uh, when should they beconcerned enough to seek help?
SPEAKER_02 (23:25):
So I like to think of warning signs in terms of
categories.
So if we think of the firstcategory as being physical signs
and symptoms, so drastic orrapid changes in weight can be
one sign or symptom.
Things like hair loss, brittlefingernails.
SPEAKER_03 (23:43):
From from nutritional depression.
SPEAKER_02 (23:45):
Absolutely, right.
Yep.
Perhaps changes in menstrualcycle, which might be less
obvious to a family member.
The second category in terms ofwarning signs would be emotions.
So a lot of anxiety around foodand eating, irritability, a lot
of distress around eating,preoccupation with food,
(24:05):
preoccupation with weight,sometimes even making comments
on other people's appearance orweight could be a warning sign.
And then the third category isbehaviors.
And so things like weighingfood, excessively exercising,
counting calories, missingfamily meals, missing social
(24:26):
functions where food isinvolved.
And what I want to emphasize isdoing any of those things
individually might not be awarning sign, but patterns of
those kinds of behaviors andemotions and physical symptoms
are probably more indicativethat something is going on.
SPEAKER_03 (24:46):
Any one of those things could be what your
teenage kid is doing.
Right.
And you don't know about yourkids' menstrual cycles, or you
don't know they're just shy, orthey're being a teenager, they
don't want to go to grandma'shouse for dinner.
So, but it sounds like maybe thepattern of those, or if if
you're starting to see them moreand more.
SPEAKER_02 (25:03):
Absolutely.
SPEAKER_03 (25:04):
What do you recommend a parent, a friend, a
partner do?
Because as you said, the theperson experiencing these
symptoms might not be veryforthcoming about them.
What should a person do?
SPEAKER_02 (25:15):
Right.
So if somebody is concerned, Ialways recommend that you find a
time where both of you can havea conversation in a calm way.
Approaching the person with yourconcerns and letting them know
why you're concerned can behelpful.
And so approaching it in anon-judgmental way, expressing
(25:38):
that you're concerned.
And then also you can give oneor two examples about objective
things that you are concernedabout.
So I'm concerned because I'venoticed that you've been missing
dinner with the family.
And then also just knowing whatto expect in terms of the
person's emotional reaction tohaving that conversation.
So it could be something likeanger or denial, but it could
(26:00):
also be a sense of relief thatsomebody has noticed and is
bringing it up.
SPEAKER_03 (26:04):
Well, that I hadn't thought of it that way.
It always seems to me to be athat that conversation's gonna
be a battle.
Maybe it doesn't always have tobe.
No.
Before we close the show, I wantto ask you a little bit about uh
people who have experiencedeating disorders and then went
on to live their lives.
So is that the norm?
I mean, do people get over thisand then go live a relatively
(26:25):
eating disorder-free life, or isthis something that they
struggle with long term?
I get it.
It's probably different from thevarious kinds.
SPEAKER_02 (26:32):
It is.
And so that's a really greatquestion.
So people can and do recoverfrom eating disorder and eating
disorder symptoms.
You know, as with most mentalhealth conditions, there can be
periods of time where some ofthose behaviors or symptoms sort
of come back, even if they'renot meeting criteria for the
(26:53):
disorder.
And so times of stress, times ofanxiety, times of transition in
life or change might be examplesof when people might see sort of
a resurgence in some of thosesymptoms.
People with eating disorderssometimes describe it as being
ever-present in some ways intheir lives, even though they
(27:14):
have learned to cope with themand you know, eat a healthy diet
and relate to themselves in adifferent way.
SPEAKER_03 (27:21):
So we're talking with Melissa Eisenmanger.
She is a doctor of psychology atHennepin Healthcare.
Melissa, what messages would youwant people to know?
If you had a minute to talk tothe public about eating
disorders, what would you likethem to know?
SPEAKER_02 (27:34):
So I think I think I would want people to know that
eating disorders are treatable.
Again, people can recover, canand do recover from them.
And getting help as early aspossible is really what is key
to improving overall health,mental health, and quality of
life.
SPEAKER_03 (27:51):
It's a great message of hope for what you might be
experiencing.
There are teams of people tohelp you.
Melissa, thank you.
SPEAKER_02 (27:58):
You're welcome.
It was so good to be here today.
SPEAKER_03 (28:00):
It's been great having you on the show.
I hope to get you back for afuture episode.
Listeners, if you need help witheating disorders, please do
check out the National EatingDisorders Hotline.
The link is in the show notes tothis.
And I thank you for listening tothis episode, the first one of
season five.
And I hope you will join us forour next episode, which drops in
two weeks.
And in the meantime, be healthyand be well.
SPEAKER_01 (28:23):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(28:44):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(29:06):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, health care,
and what matters to you.
And now here's our host, Dr.
David Hilden.
SPEAKER_03 (00:18):
Hey, hey, everybody, and welcome to the first episode
of season five of the HealthyMatters Podcast.
I am your host, David Hilden.
I am so glad you've stuck withus through four incredible
seasons of the show.
Thank you to everybody forlistening, and thank you to my
numerous guests from HennepinHealthcare and beyond.
Today, we're going to talk abouteating disorders.
(00:41):
You know food is supposed tobring us comfort in life and
nourishment from grandma'sfamous chocolate chip cookies to
a late-night pizza run.
However, for many people, foodcan also be a source of fear,
anxiety, and serious illness.
Eating disorders affect nearly30 million people in the United
States alone, and nearly 15% ofall women will experience one in
(01:02):
their lifetime.
But what makes these conditionsso common?
To help us unpack all of this isDr.
Melissa Eisenmenger.
She is a clinical psychologistand someone who knows this topic
inside and out.
Dr.
Eisenmenger, thanks for beinghere.
SPEAKER_02 (01:14):
Thank you for having me.
SPEAKER_03 (01:15):
Could you start with some of the basics about eating
disorders?
What are they?
Or you know, just define it forus if you could.
SPEAKER_02 (01:22):
Sure.
So eating disorders broadly arecomplex and serious conditions
that not only affect mentalhealth but also physical health.
And we can see disturbances inthings like thoughts, behaviors,
and emotions as they relate tofood, eating, and one's
relationship to food.
And also disturbances in the waythat people see themselves in
(01:45):
terms of their body weight,shape, and size.
And these disturbances causequite a bit of distress for
people, an impairment infunctioning.
I'd like to point out that a keydifference between disordered
eating and an eating disorder isnot only in the frequency and
intensity of the symptoms inbehaviors, but also in how much
(02:05):
food tends to dominate, disrupt,and really permeate lots of
different areas of a person'slife.
SPEAKER_03 (02:12):
I had heard the word eating disorders decades ago,
although I do have to admit, notmuch in medical school.
But I had not heard the termdisordered eating to maybe the
last decade.
Could you tell us a little bitmore about that?
So is disordered eating just anadjective for people who have a
troubled relationship with food,or is that a diagnosis?
SPEAKER_02 (02:33):
So disordered eating is not a diagnosis, and it is
more when clinicians seesomething like maladaptive
eating patterns.
I have some examples of thatthat are pretty specific, like
something called orthorexia, forexample.
I don't know if you've heardthat.
SPEAKER_03 (02:49):
No, but what's orthorexia?
SPEAKER_02 (02:50):
Yeah, so orthorexia, the term has been around for 25
to 30 years, but it's coming tomore of the attention of medical
professionals and dietitians.
And orthorexia is when somebodybecomes really fixated on a
circumscribed diet and theymight have really very rigid
rules around what can be eatenor when things can be eaten.
(03:13):
And there are lots of differentexamples of orthorexia, but
orthorexia is one example ofsomething that we can see either
coming into or going out of aneating disorder.
And so that might be, again, oneexample of that maladaptive or
disordered eating.
SPEAKER_03 (03:28):
Is that always a bad thing?
Is it always a disorder leadingto a full-blown eating disorder?
Or is that just is it all youknow what I'm getting at?
Is it always a bad thing?
SPEAKER_02 (03:40):
Aaron Powell So it's more of a matter of degree.
And again, I would say how muchum a pattern of disordered
eating is disrupting a person'slife and causing that distress
and impairment in their lives.
SPEAKER_03 (03:52):
Aaron Powell We're gonna talk about specific
diagnosable eating disorders alittle bit in the show, but
could you just kind of give usum uh why do people get these?
What are there risk factors fordeveloping eating disorders?
SPEAKER_02 (04:03):
Yeah, there are lots of different risk factors, and
it's probably a combination ofthose risk factors that
contribute to somebodydeveloping an eating disorder.
So some of the differentcategories can include things
like psychological factors.
So things like depression,anxiety, trauma, post-traumatic
stress disorder, difficultieswith coping, having a lot of
(04:26):
stress and few coping skills canbe things that predispose
somebody to developing an eatingdisorder.
The other thing is environmentalfactors.
So things like bullying,pressures from family or friends
or peers to lose weight,certainly social media, diet
culture.
Another element can betemperament.
(04:46):
So specifically, we know thatthings like perfectionism can
contribute to the development ofan eating disorder.
And then finally, there aregenetic and biological factors
that can also contribute.
SPEAKER_03 (04:56):
So lots of different risk factors.
Right.
At the beginning in my intro, Imentioned some pretty staggering
statistics that a lot of peoplehave eating disorders or have
experienced them at some pointin their life.
Why are those numbers so high?
And the follow-up to that is isit going up?
Is it down?
Is it stable?
SPEAKER_02 (05:12):
Yeah, so those numbers are really high.
And again, in part, there'sprobably no one reason.
Social media and again, diet anddiet culture really probably
contribute to those highnumbers, as well as things like
social pressure to achieve thissort of thin ideal.
SPEAKER_03 (05:29):
Why are women affected more than men?
But men are as well.
I think we've got to be clearabout that, right?
SPEAKER_02 (05:34):
Yes, so absolutely.
So women do tend to be affectedmore than men, and that can also
be for a variety of reasons.
So biologically, women might bemore predisposed because of
things like hormones and brainchemicals called
neurotransmitters.
There might be socioculturalinfluences.
So again, I'm thinking aboutsocial media, how diet
(05:56):
advertisements tend to targetwomen.
Women feel more pressure to bethin.
There are a lot of things outthere on social media that again
target women and sometimes evenmake it seem very easy to lose
weight or to go on one of thesefad diets.
There might also be a bit ofdiagnostic bias.
Eating disorders are primarilyseen as a women's problem.
(06:20):
And so that might mean that formen, it goes unrecognized,
underdiagnosed, andundertreated.
And then finally, if we thinkabout mental health conditions
such as depression and anxietybeing comorbid with eating
disorders, we know that thosemental health conditions also
affect women more than theyaffect men.
SPEAKER_03 (06:40):
So why are they on the rise?
SPEAKER_02 (06:41):
An interesting fact is that eating disorders doubled
between 2000 and 2020.
So the rate doubled.
SPEAKER_03 (06:48):
It's gotta be social media.
SPEAKER_02 (06:50):
Absolutely.
So a large factor here is socialmedia.
SPEAKER_03 (06:53):
Well, that's staggering.
SPEAKER_02 (06:54):
Yes, it is.
SPEAKER_03 (06:55):
Doubled in the last 20, 25 years, and it's roughly
the same time as social media.
SPEAKER_02 (06:59):
Yes, absolutely.
SPEAKER_03 (07:00):
I want to delve into that a little bit more.
Is that an intentional thing?
Or is this, I mean, are thereorganizations or companies that
are just marketing, or is thislike an amplification of what
used to happen in the middleschool lunchroom and the
pressures there?
Now it's just more amplified.
Do you get what I'm saying?
SPEAKER_02 (07:17):
I do maybe more so the latter.
And so you're right in thateating disorders existed before
social media.
Now there are a lot of forumsthat people can go on in social
media targeting different, youknow, fad diets again and
different ways of eating,different ways to lose weight.
Social media influencers mightcontribute a great deal to how
(07:38):
people believe that they shouldlook or kind of a stigma even
against obesity or beingoverweight.
Another thing that hascontributed to the rise, really
interesting though, is with theonset of the pandemic, the
COVID-19 pandemic.
And so I know that the NationalEating Disorders Association saw
a pretty drastic rise in callsto their helpline between 2019
(08:00):
and 2020, in the same months in2019 and 2020.
And so, you know, the pandemicled to people being much more
isolated, having meals sociallya lot less often, being more
sedentary, having constantaccess to food, and kind of
being out of a normal day-to-dayroutine.
SPEAKER_03 (08:19):
And sitting on their screens.
SPEAKER_02 (08:20):
Absolutely.
Yeah.
Absolutely.
SPEAKER_03 (08:22):
Yeah.
So many people think that eatingdisorders are all about maybe
vanity or I'm just dieting, I'mdieting, and it just went a
little bit too far.
It's a little bit more thanthat, I think, um, probably.
Is can you briefly address thatnotion?
SPEAKER_02 (08:37):
Absolutely.
So first let me address thepiece about vanity.
So it can be sort of a damagingoversimplification to think that
eating disorders are because ofvanity.
Most of the time, eatingdisorders start out as a
protective function for theperson.
It gives the person a sense ofstructure.
(08:58):
It gives the person a way tocope with internal or external
chaos.
It gives the person a way tocope with stress or emotion
dysregulation.
As an eating disorder takeshold, what can happen is that
then we start to develop theseideas about what our bodies
should look like.
And that tends to fuel then moredisordered eating.
SPEAKER_03 (09:19):
Let's shift and talk about the various types of
eating disorders.
Could you talk us through whatthe big ones are?
SPEAKER_02 (09:25):
Sure.
So binge eating disorder entailseating binges, of course.
And so eating binges have twodifferent sort of criteria that
we look for.
One is eating a very largequantity of food in a discrete
period of time, usually twohours or less.
And this would be an amount offood that would go above and
beyond what most people wouldeat in a similar period of time.
(09:47):
And the second thing for aneating binge would be a loss of
a sense of control over one'seating.
And this is really a hallmark ofan eating binge, and it
distinguishes overeating from aneating binge.
SPEAKER_03 (10:00):
That you simply can't stop?
SPEAKER_02 (10:02):
Right.
So some people say that theycan't stop.
Some people say that theystarted out intending to eat a
certain amount, and then beforethey knew it, they were getting,
you know, a third or fourthhelping or ordering more food.
It can be an urge that peoplehave to continue eating, even
though they feel veryuncomfortably full.
So for binge eating disorder,the binges are one piece of it.
(10:25):
But then there are also thingslike, again, eating until
feeling uncomfortably full.
Eating large amounts of food, itcan be a lot of distress,
feelings of guilt and anger andfrustration and disgust around
an eating binge, eating rapidly,or eating alone because you're
embarrassed about eating.
SPEAKER_03 (10:44):
Is that the same as bulimia nervosa?
SPEAKER_02 (10:47):
So it's not.
That's a really good question.
So bulimia in bulimia nervosa,there are eating binges.
So that eating a very largequantity of food and a loss of a
sense of control over one'seating.
But then there are alsocompensatory behaviors that a
person intends to kind ofcorrect for the overeating or
(11:08):
binge eating and are also meantto prevent weight gain.
So when I say compensatorybehaviors, what I mean by that
are purging by vomiting.
It could be use of laxatives oruse of diuretics.
It can be excessive fasting orrestriction, or it could also be
excessive exercise.
SPEAKER_03 (11:28):
Who uh is most at risk for those two?
The binge eating disorder andthe bulimia nervosa.
SPEAKER_02 (11:35):
So those two are a little bit different in terms of
who's at most risk.
Um, for binge eating disorder,we really see more of kind of
broad brushstrokes over who isaffected by that.
It can be people of normalweight, it can be people who are
obese, it can be people who areunderweight, you know, eating
disorders in general.
There's some research to suggestthat it affects different racial
(11:59):
and ethnic groups prettysimilarly for those living in
the United States.
For binge eating disorder inparticular, it tends to affect
women just as much as it affectsmen.
For something like bulimia, onthe other hand, it's much more
common in women, probably threeto four times more common in
women than in men.
SPEAKER_03 (12:19):
So that compensatory mechanism, is that largely to
maintain a weight, to not gainweight?
Is that largely why?
SPEAKER_02 (12:26):
It is, although it doesn't always end up in reduced
weight or people beingunderweight.
Um sometimes people with bulimiaare of normal weight or are
overweight.
SPEAKER_03 (12:35):
Okay, turn to anorexia nervosa, if you could,
please.
SPEAKER_02 (12:39):
So anorexia nervosa is defined by restriction of
calories or energy intake inrelation to what one really
needs to maintain a healthyweight, and so people can become
very underweight.
There's an intense fear ofgaining weight or becoming fat.
(13:00):
And there can be distortedperceptions on what one's body
looks like.
There can be lack of insight asto how serious the disorder has
become, and there can be a senseof self-worth that is unduly
influenced by one's body weight,shape, or size.
SPEAKER_03 (13:18):
Aaron Powell Is this one mostly in girls and women?
SPEAKER_02 (13:21):
It is, again, about three to four times more likely
to affect girls and women.
SPEAKER_03 (13:26):
Aaron Powell So those differences in males and
females.
Could you comment a little bitabout the effect on the
transgender community?
SPEAKER_02 (13:32):
Absolutely.
So we know that transgender andnon-binary individuals have
higher rates of all of thoseeating disorders that I just
mentioned in relation to theircisgender counterparts.
SPEAKER_03 (13:43):
Aaron Powell When do these typically develop?
I know there we've just talkedabout three separate diagnosed
eating disorders, but when dothey typically develop?
SPEAKER_02 (13:52):
That is stratified based on the eating disorder
itself.
So for something like anorexianervosa, we tend to see the
development between roughly agesof 12 and 15, sometimes
coinciding with the onset ofpuberty.
For something like bulimianervosa, the median age of
developing something like thatwould be closer to 18 or 19
(14:14):
years old.
And then for binge eatingdisorder, it tends to be a
little bit later, so around age21.
Although it should be said thatall of these things can be
diagnosed much later in life.
SPEAKER_03 (14:24):
We're gonna talk much more about what it's like
to diagnose, treat, and getsupport for all of these after
the break.
We have been talking to MelissaEisenmanger.
She is a doctor of psychologyand a colleague of mine here at
Hennepin Healthcare in downtownMinneapolis.
We're talking about eatingdisorders.
We are gonna take a short break,and I hope you'll join us when
we come right back.
SPEAKER_00 (14:47):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(15:09):
chiropractic care.
Learn more atHennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (15:24):
And we're back talking with Dr.
Melissa Eisenmenger.
She is a psychologist and we aretalking about eating disorders.
So, how are they typicallydiagnosed?
SPEAKER_02 (15:33):
Yeah, so eating disorders in particular can be
really challenging to diagnose,in part because people tend to
be relatively secretive aboutthe disorder, because again, we
need to think about thatprotective function that they
serve for people.
So, unlike things like medicalconditions or even some other
mental health conditions, peopledon't necessarily want to be
(15:57):
treated for their eatingdisorder because it is serving
that function.
And so sometimes it does comeacross in a medical visit for
people when there's somethingthat is noticed in terms of a
drastic weight change orsomething that might come up on
abnormal blood work.
It might be something that'snoticed by family or friends
that's brought to somebody'sattention.
(16:18):
But again, these can be reallychallenging to identify and to
get people to talk about.
SPEAKER_03 (16:23):
Who typically diagnoses them?
SPEAKER_02 (16:26):
So mental health professionals can diagnose
eating disorders, and that wouldbe based on the criteria that we
talked about for each of thoseeating disorders.
SPEAKER_03 (16:34):
Is it true that the diagnosis is sometimes delayed
because it because of whatyou've just said, people are a
little bit more secretive aboutit.
Maybe they don't have a mentalhealth professional, maybe they
have a pediatrician, maybe theyhave a family doctor, a general
internist like me.
SPEAKER_02 (16:48):
Yeah.
And so you're right about thedelay and diagnosis.
And we also know that the longerdiagnosis is delayed, the longer
treatment is delayed.
And so these eating disorderscan become more dangerous over
time for a variety of reasons.
But yeah, absolutely.
Probably primary care officesare maybe kind of the first line
(17:08):
of identification and gettingsomebody into treatment for
eating disorders.
SPEAKER_03 (17:13):
What are some of the common treatment approaches?
SPEAKER_02 (17:16):
That's a really good question.
So for something like bulimiaand binge eating disorder, CBT
or cognitive behavioral therapyhas been shown to be effective.
And cognitive behavioral therapyrevolves around the idea that
our thoughts, emotions, andbehaviors are all linked.
And so CBT for something like aneating disorder would focus on
(17:40):
thoughts that perpetuate andmaintain an eating disorder.
For example, there's an enhancedform of cognitive behavioral
therapy for eating disorders,which has a little bit more
psychoeducation specific toeating disorders.
SPEAKER_03 (17:53):
Where do people find a professional that is skilled
in CBT?
SPEAKER_02 (17:56):
Yeah.
So if I see somebody in need oftreatment for an eating
disorder, what I usually do isrefer to somebody who has a
specialty in eating disorder oran eating disorder program like
the ones that we have here, someof the programs that we have
here in the Twin Cities.
SPEAKER_03 (18:12):
Say more about those if you could.
Are those outside of yourpsychologist, your primary
doctor, there are specialtyprograms.
And in the Twin Cities, we havesome of them.
I'm sure if you are listening tothis in California, New York, or
Texas, you probably have them aswell.
What are those programs like?
What happens there?
SPEAKER_02 (18:30):
So usually programs, people get treatment based on
how severe their eating disordermight be.
And so it might be a combinationof individual and group
therapies on an outpatientbasis.
It might be residentialtreatment, but uh a combination
of individual and group therapyis usually what is offered and
what is best.
SPEAKER_03 (18:50):
Is there a role for medication?
SPEAKER_02 (18:53):
So I'm not a prescriber, so I don't want to
speak too much about themedications.
What I would say that I consideris having somebody that is
hooked in with a prescriber whois familiar and has expertise in
working with eating disorders.
You know, I believe that some ofthe medications that are
(19:14):
prescribed for things likedepression and anxiety, which
can be comorbid with an eatingdisorder, are actually
contraindicated for some peoplewith anorexia and bulimia.
So I don't want to speak toomuch to the specifics of what
those medications are.
It's not necessarily mywheelhouse.
SPEAKER_03 (19:32):
That's a good approach.
I do prescribe medications everyday in my life as a primary care
doctor, and I wouldn't do thisonce without someone's
expertise.
I think that that's a reallygood point to note to if you, a
loved one, or you are wonderingif you have an eating disorder
or you've been diagnosed withone, the right treatment
approach is not to rely on yourprimary care doctor to give you
(19:54):
something in a pill bottle.
What you said at the beginningis far more important.
Cognitive behavioral therapy,get the right supports that you
need in or outside of a program,but you need somebody who knows
this field very specifically.
What about nutritionalcounseling?
Does that happen in I I assumeit happens in treatment centers.
Is that a good route to go?
SPEAKER_02 (20:15):
Yeah, absolutely.
So treatment centers usuallyhave dietitians on board again
who are familiar with, havespecialty in eating disorders.
So nutritional nutritionalcounseling is incredibly
important, whether we're talkingabout binge eating disorder,
anorexia nervosa, or bulimianervosa.
Some programs I believe alsoincorporate physical therapists
(20:36):
to help people get a healthysense of, you know, movement and
what healthy exercise lookslike.
SPEAKER_03 (20:42):
I'm gonna move to it to something a little bit maybe
harder to hear.
What are some of theconsequences that you see of
untreated eating disorders?
It can be serious, right?
SPEAKER_02 (20:53):
It absolutely can.
And as I mentioned earlier, thelonger an eating disorder goes
untreated, sometimes the moredangerous they become.
For anorexia nervosaspecifically, it's the mental
health disorder with the highestrate of mortality.
And so that that mortality riskincreases as the years go by.
(21:16):
Risk of malnutrition withsomething like anorexia or
bulimia nervosa, an electrolyteimbalance, especially again as
these things kind of proceedover the longer term.
For something like binge eatingdisorder, if that is leading to
overweight or obesity, that canalso have or end up leading to
health complications.
SPEAKER_03 (21:36):
So true physical uh uh health complications.
And some of them, I r I rememberwhen I was a child, the most
famous one uh of all, um thewoman with the most beautiful
voice you've ever heard in yourlife, Karen Carpenter, was on
the front page of a newsNewsweek or something.
None of us had heard of it.
And she had died of anorexianervosa.
(21:56):
And and that was what it openedum many of our eyes.
I was just a kid, uh um, but Iremember it um kind of rather
vividly.
So there are some seriousconsequences.
Could you talk about emotionalconsequences, not only to the
person who has the eatingdisorder, but to their family
and in their relationships?
SPEAKER_02 (22:15):
Sure.
So again, um, comorbiddepression and anxiety, as well
as trauma and post-traumaticstress disorder, can affect
people with eating disorders.
People with eating disorderssometimes feel a lot of shame or
guilt over what is happening.
And so that is also what canprevent people from getting the
(22:37):
treatment in a timely manner.
On families, you know, it can befeelings of guilt, certainly
fear, helplessness, not knowinghow to approach a loved one that
they might suspect has an eatingdisorder.
There can be feelings of blametoward oneself or toward the
person with an eating disorder.
(22:58):
Sometimes that can lead tofamily discord.
And we know that the more kindof dysfunctional a family unit
or the more discord there is ina family, sometimes that can be
associated with more eatingdisorder symptoms.
SPEAKER_03 (23:12):
Could you give us advice on when a parent or a
partner or a good friend or thea person, him or herself, their
self, uh, when should they beconcerned enough to seek help?
SPEAKER_02 (23:25):
So I like to think of warning signs in terms of
categories.
So if we think of the firstcategory as being physical signs
and symptoms, so drastic orrapid changes in weight can be
one sign or symptom.
Things like hair loss, brittlefingernails.
SPEAKER_03 (23:43):
From from nutritional depression.
SPEAKER_02 (23:45):
Absolutely, right.
Yep.
Perhaps changes in menstrualcycle, which might be less
obvious to a family member.
The second category in terms ofwarning signs would be emotions.
So a lot of anxiety around foodand eating, irritability, a lot
of distress around eating,preoccupation with food,
(24:05):
preoccupation with weight,sometimes even making comments
on other people's appearance orweight could be a warning sign.
And then the third category isbehaviors.
And so things like weighingfood, excessively exercising,
counting calories, missingfamily meals, missing social
(24:26):
functions where food isinvolved.
And what I want to emphasize isdoing any of those things
individually might not be awarning sign, but patterns of
those kinds of behaviors andemotions and physical symptoms
are probably more indicativethat something is going on.
SPEAKER_03 (24:46):
Any one of those things could be what your
teenage kid is doing.
Right.
And you don't know about yourkids' menstrual cycles, or you
don't know they're just shy, orthey're being a teenager, they
don't want to go to grandma'shouse for dinner.
So, but it sounds like maybe thepattern of those, or if if
you're starting to see them moreand more.
SPEAKER_02 (25:03):
Absolutely.
SPEAKER_03 (25:04):
What do you recommend a parent, a friend, a
partner do?
Because as you said, the theperson experiencing these
symptoms might not be veryforthcoming about them.
What should a person do?
SPEAKER_02 (25:15):
Right.
So if somebody is concerned, Ialways recommend that you find a
time where both of you can havea conversation in a calm way.
Approaching the person with yourconcerns and letting them know
why you're concerned can behelpful.
And so approaching it in anon-judgmental way, expressing
(25:38):
that you're concerned.
And then also you can give oneor two examples about objective
things that you are concernedabout.
So I'm concerned because I'venoticed that you've been missing
dinner with the family.
And then also just knowing whatto expect in terms of the
person's emotional reaction tohaving that conversation.
So it could be something likeanger or denial, but it could
(26:00):
also be a sense of relief thatsomebody has noticed and is
bringing it up.
SPEAKER_03 (26:04):
Well, that I hadn't thought of it that way.
It always seems to me to be athat that conversation's gonna
be a battle.
Maybe it doesn't always have tobe.
No.
Before we close the show, I wantto ask you a little bit about uh
people who have experiencedeating disorders and then went
on to live their lives.
So is that the norm?
I mean, do people get over thisand then go live a relatively
(26:25):
eating disorder-free life, or isthis something that they
struggle with long term?
I get it.
It's probably different from thevarious kinds.
SPEAKER_02 (26:32):
It is.
And so that's a really greatquestion.
So people can and do recoverfrom eating disorder and eating
disorder symptoms.
You know, as with most mentalhealth conditions, there can be
periods of time where some ofthose behaviors or symptoms sort
of come back, even if they'renot meeting criteria for the
(26:53):
disorder.
And so times of stress, times ofanxiety, times of transition in
life or change might be examplesof when people might see sort of
a resurgence in some of thosesymptoms.
People with eating disorderssometimes describe it as being
ever-present in some ways intheir lives, even though they
(27:14):
have learned to cope with themand you know, eat a healthy diet
and relate to themselves in adifferent way.
SPEAKER_03 (27:21):
So we're talking with Melissa Eisenmanger.
She is a doctor of psychology atHennepin Healthcare.
Melissa, what messages would youwant people to know?
If you had a minute to talk tothe public about eating
disorders, what would you likethem to know?
SPEAKER_02 (27:34):
So I think I think I would want people to know that
eating disorders are treatable.
Again, people can recover, canand do recover from them.
And getting help as early aspossible is really what is key
to improving overall health,mental health, and quality of
life.
SPEAKER_03 (27:51):
It's a great message of hope for what you might be
experiencing.
There are teams of people tohelp you.
Melissa, thank you.
SPEAKER_02 (27:58):
You're welcome.
It was so good to be here today.
SPEAKER_03 (28:00):
It's been great having you on the show.
I hope to get you back for afuture episode.
Listeners, if you need help witheating disorders, please do
check out the National EatingDisorders Hotline.
The link is in the show notes tothis.
And I thank you for listening tothis episode, the first one of
season five.
And I hope you will join us forour next episode, which drops in
two weeks.
And in the meantime, be healthyand be well.
SPEAKER_01 (28:23):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org.
Or call 612-873-TALK.
There's also a link in the shownotes.
(28:44):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers are JonathanComito and Christine Hill.
Please remember we can only givegeneral medical advice during
this program.
And every case is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(29:06):
Until next time, be healthy andbe well.
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