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and good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne, I'm your host Mark Evans.

Proud to say I've been around since what about two thousand seven or so?

>> Wow.

A lot of years a lot of HealthLine line programs and it's great to be here.

I want to go ahead and let you know that this is an interactive program if you're watching it for the first time, the telephone number is on your screen to call in because we do expect some calls tonight on this topic and of course we're going to be talking about something that I think a lot of people especially in the United States can relate to and that's eating disorders and how those are caused how we can treat those and there are a number of them.

>> So we'll go over those and please by all means, if you yourself have an eating disorder or someone you love or care about has one and you want more information, give us a call.

That's what this show is all about 866- (969) 27 two zero.

>> Our special guest tonight is Dr. Laura OIga.

>> She is a psychologist and you were here back during the covid days and we talked about something similar during that show and I remember we had a lot of phone calls so I suspect that we'll have plenty tonight.

>> So thank you for being here and taking time out of your busy schedule.

You're welcome.

I want to go ahead and start about how common eating disorders are and who's most at risk to so eating disorders.

I think for a lot of folks they don't realize that they actually are quite common.

They actually are as common if not more common than major depressive disorder or generalized anxiety disorder.

And so a lot of people have heard of anxiety or depression ,not realizing that eating disorders are in fact more common than those in someone's lifetime.

And so yes, we see them we see them happen a lot and I think because people expect them to look a certain way and don't really know much about them, I think that can kind of feel confusing for folks of like why that doesn't make any sense.

Most at risk are oftentimes adolescences when we see the eating disorder starting, however, folks can maybe struggle their whole life or that we can see eating disorders pop up later in life as well.

So they don't necessarily relate to one particular age population but we do see them happen a lot in adolescence.

>> But we're going to talk about various eating disorders.

But is there a general reason of what causes them?

You know, eating disorders are kind of this perfect storm or they they kind we need this whole puzzle.

Right.

There's a lot of pieces to it and so there's not one cause but some of the major things that we know can cause an eating disorder include genetics.

So there is a genetic component to it.

We also know that personality style certain personalities are more prone to eating disorders oftentimes social types of things.

So things like maybe social media, our culture that's all about weight loss and dieting.

In fact dieting is often the number one thing that can cause an eating disorder regardless of which type which we'll get into today.

And so it's really kind of this, you know, sort of perfect storm of events that come together and really cause one to start to develop an eating disorder and are all individualistic.

>> I mean everybody has even if you have let's say bulimia nervosa, it's going to affect you probably differently than somebody else who has the same disorder.

>> Sure.

And different triggers I'm sure I've learned that I think from the last time I talked to you and plus we've had other shows talking to various physicians about eating disorders as well.

>> So let's go ahead and talk about some of the most common eating disorders and I know that binge eating is probably at the top of the list.

>> Would you like to start with that one?

Absolutely.

So I think that's another common misconception is that most people when they think about an eating disorder they think of someone who's very thin and struggling more with maybe the under eating but in fact we actually see the most common is binge eating disorder and that really is characterized by somebody who struggles with overeating and eating what more than what a normal person would eat and that that's happening pretty frequently and there's a lot of times, you know, things underlying that that are driving the eating disorder.

So they're driving that behavior with food.

So it's not just, you know, just a behavior but it's there's a lot of mental health maybe psychological components that go along with that too.

>> Yeah, as a matter of fact, I want to ask you about the binge eating.

I mean and I don't want that to be confused with the bulimia but do people actually do that enough binge eating where they get sick?

>> They can yes.

But that's not the premise.

I mean they don't want to get sick.

I mean that's not necessarily the part of it because I know that bulimia nervosa is quite different and we're going to get in that just a second.

But so another question I want to ask is what the lack of certain vitamins or nutrients bring on the binge eating it definitely could and I think I think more of you know, if someone is only eating maybe let's say protein and really heavy protein, well their body might actually be needing carbohydrates.

And so if they're restricting a certain type of macro or icronutrient, they and they're trying to stay away from it.

Their body made me go and want to have balance that out and so they may be more likely to binge.

So a lot of times, you know, when I'm working or when we work with folks with eating disorders, especially with binge eating, oftentimes they are eating very little throughout the day and then often there's a lot of that binge eating in the evening time.

And so one intervention of many is often really working with trying to get them eating more regularly and eating more balance throughout the day.

So it's less likely that they have a physiological binge right.

Their body is not going to naturally want to go binge.

>> They might still have emotional or psychological binges but those are kind of we'd intervene with those in different ways.

>> Well, and I would imagine not only is it good for your waistline but it's probably binge eating is not really good on most of your internal organs, I would imagine.

>> Sure.

Yeah.

And I think one of the things you kind of mentioned waistline.

>> Right.

And I just want to say something there is that I think the the misnomer too is that binge eating can happen and only maybe if someone's in a larger body and that's not necessarily the case either way.

So you can see it in lots of differen ways.

But yeah, I think it is something that affects a lot of different people and in it in the physical health as well.

>> OK and if you want to talk about anorexia nervosa yeah.

>> That's one of the eating disorders.

Yes.

So anorexia nervosa this is one that a lot of people I think are most commonly maybe think about when they think of an eating disorder but it's when an individual is really under eating with their body needs in terms of calories for each day and oftentimes when they're in this calorie deficit they they really start to have a lot of eating disorder thoughts.

So sometimes we talk about this eating disorder voice that's in their head that's really maybe mean and cruel to them.

It's telling them, you know, obsessing about food and weight in their body and what we find is as we start to really get their brain and body nourished where it needs to be that that voice quiets.

It may not go away but it actually quiets down quite a bit.

And so nutrition and rehabilitation around food and getting that person, you know, gaining weight, weight restored or where their body needs to be is really important and getting a person to recovery .

>> OK, we do want to talk about bulimia nervosa in just a moment I'm going to go ahead and yield the floor to Ben who is actually preferring to stay offline.

He'd like for us to read his question.

So Ben is asking would intermittent fasting be considered as an eating disorder?

>> Mm hmm.

That's a really good question and my answer is it depends because I think, you know, intermittent fasting I think is one of those things that for someone that doesn't have the genetics or the predisposition to have an eating disorder, that person may be able to go and do this and whether it's good or not good for their health right to be determined.

>> However, I think the person that has the genetics starting that intermittent fasting could actually kick off an eating disorder.

So whether that's you know, it leads them to continue restricting or maybe it leads them to sorry my mind keeps a lot of it could lead them to restricting and then bingeing because they've they've been in this deficit for a period time.

So I think it's it's something that it may or may not be part of someone's eating disorder.

>> All right.

Very good.

And then bulimia nervosa, anorexia and bulimia are the two ones that I have heard of course was binge eating probably the two top ones that I've heard of exactly what is bulimia nervosa.

>> So bulimia nervosa is when someone is doing the binge eating part of it so they're overeating a large amount of food and then they do something after to get rid of it because there's something we call it kind of purging, been purging a lot of people think maybe it's just, you know, trying to vomit but it could also be that they're overexercising or compulsive moving their body or exercising to burn the calories they eat.

It could also be abusing or overusing laxatives to try to kind of get rid of what they eat and it can also be restricting.

And so that's one that's confusing for people is sometimes they don't realize that overeat and then trying to, you know, limit or restrict your diet sort of the next day or two to make up for what you did.

That can actually be a purge as well.

And so it's kind of that back and forth that pendulum swinging of overeating and then trying to do something to kind of make up for it and then kind of swinging back and forth.

>> Well, what motivates that is that a fear of gaining weight because of the calories or is it the feeling of fullness they don't like or too full or maybe about?

>> Oh yes.

I think I would say both absolutely.

I mean I think a lot of times the binges with binge eating or with bulimia nervosa can be quite large for people and that could be very distressing.

>> All right.

And I was kind of amazed I was finding some things as I was doing research for the show earlier today.

But I guess female athletes are a afflicted with some things, some eating disorders.

>> Can you explain some of those or explain what that means?

Yeah, So female athletes there's there's this thing called the female athlete triad that they found in research and what that is is when a female athlete has a limited amount of calories that they're eating or it could be that they're eating but because of their sport is requiring them to burn so many calories they're in, you know, a calorie deficit.

So you've got a lack of enough calories coming in every day and then that can lead to maybe problems with menstrual cycle and or it can also lead to some bone density problems and so the bones are not as strong because they're not getting enough nutrients and calories in their body because either they're not eating enough or they are eating enough but then they're using that fuel in their sports or pushing themselves maybe too far at times.

>> So that's something that we see sometimes and that can cause chronic fatigue.

The dehydration, anemia and it also throws menstrual cycles off path it can.

>> OK, all right.

>> Well we have another call coming in Racheal asking us to read her question.

She says I read that anxiety disorders could lead to eating disorders.

>> Is there any truth to this?

There can be truth to that.

Absolutely.

I think if you think about anxiety it really impacts our whole body for a lot of people.

And what we know is when our body is feeling quite anxious it actually can impact our digestive system.

It can make us not feel so hungry.

It can make us lose our appetite and so or because are so anxious we may turn to food to kind of comfort and calm down.

So I honestly think that most eating disorders have some element of an anxiety disorder sort of in their that's not to say everyone with an anxiety disorder develops an eating disorder but I definitely see people with eating disorders often having a co occurring anxiety disorder.

>> I could see that I can see the connection there.

Let's talk about the treatments for various eating disorders and I'm sure that for each one that we talked about there's probably a different way to go.

>> But generally right off the top don't we have to treat these on a team like basis?

>> We do, yes.

So we use what's called a multidisciplinary team and these teams really consist of at least usually three core providers.

So usually you have at least a therapist or psychologist kind of working on the mental state working on the thoughts, the feelings, maybe past stressors or traumas, working on family dynamics, working on kind of just a lot of pieces that are both part of the food but then also maybe underlying the eating disorder.

So usually you have some kind of mental health provider.

You also have a dietician and you definitely want that to be someone who is specialized in eating disorders because if this person isn't specialized they might be suggesting, you know, diets that actually aren't going to be helpful for the person.

So it needs to be someone who has some training in eating disorders So mental health provider dietitian and then third at minimum would want a physician again ideally someone who knows about eating disorders and understands some of the nuances with that and maybe some of the health risks to be looking out for .

And then you may also work with psychiatrists psychiatrist so someone to work with prescribing maybe medications for anxiety.

We see OCD, we see depression, bipolar, you know, some different maybe psychiatric disorders that go along with eating disorders as well.

>> And you know, there is another phenomenon is that some medications that some patients are taking can also cause the weight gain and how is that dealt with?

>> Yeah, so that's a tricky balance because I think on the one hand right weight gain can definitely be a trigger for certain eating disorders.

And so so there is that and the other on the other hand we have to treat the person as a whole and if they have a psychiatric illness that really is impairing them and they find a medication that really can help with that, we kind of have to to work with that and usually that's part of that treatment team approach as we talk through and get a talk with all the providers to and with with the client or patient themselves to kind of help us guide and make those decisions.

>> I know a lady who is desperately trying to lose weight and she's in a couple of medications and she's been on a particular diet and hasn't lost a whole lot and is they finally succumbed to the fact that it's her medications and right now they're trying to find alternatives that aren't going to affect her dieting or I should say that the dieting will certainly not be affected by those medications.

So I guess if something doesn't work you still have to go back pand you have to, you know, get some more counseling and figure out what the heck is going on because it's just not fair if somebody is really following a diet and exercising more and unfortunately they're just not losing weight.

>> But I guess it does happen from time to time.

Well, it's something I might just jump in there if that's OK and say that, you know, one of the things that we work really hard on with eating disorders is actually focusing not on weight as much.

Obviously it's a piece of it but for a lot of our folks, you know, they they have to learn how to recover in the larger body and and body acceptance is really important.

And so yes, there's some caveats around me.

You know, weight loss.

But I also think for for working with this population a lot of the work is actually not being OK if we don't lose the weight because you know, people in larger bodies can't actually be healthy and they can be very happy, you know, and so and so I think kind of sometimes challenging that idea that you know, is weight loss actually even necessary for this person to be healthy mind, body and spirit.

>> OK, well you touched on a subject there and I want to get back to it just a second but we have another call coming in.

It's from Kate prefers to read her question too.

>> We'd love to hear your voices but that's OK. We'll transcribe them for you.

Do you have any advice on approaching a loved one who may be struggling?

>> Oh, well, I was going to ask that.

I'm glad you did.

Yes, Oh, that's a great question, Kate.

I think part of the illness is that there's this really fun word and so it describes this part of the disorder where people just don't realize how sick they are and they they really want to minimize their symptoms.

They don't think they're sick enough.

And so a lot of times it takes a loved one bringing them to treatment or nudging them sometimes scheduling the appointment and just saying let's go get an assessment done.

You know, we I have a suspicion I see this as you struggling and so I think sometimes just showing love just kind of encouraging them to go get an assessment, maybe go with them, maybe help them call and schedule something sometimes too even before you may be pushed for treatment or assessment.

You could also just acknowledge and just say hey, you know, I've noticed X, Y and Z I'm really concerned about you or you know, I'm wondering just what's going on and just sort of be really compassionate and really curious and ask more questions.

But I think just acknowledging it because a lot of times their brain just doesn't they don't they don't see it as a problem.

And so and they can minimize it as well and oftentimes because you think an eating disorder needs to look a certain way if they don't see themselves looking that way they just aren't going to think they have a problem.

>> Right.

Right.

Well, we are talking to Dr. Laura OIR who is a psychologist .

Our topic tonight eating disorders.

Please give us a call.

We have around ten minutes or so left in the program.

Looks like another call coming in.

>> But before we answer that one, I want to go ahead and move on here other than disorder's eating disorders affecting you physically and you touched on this a little bit earlier in our conversation.

But I think it's so important we need to know about this.

>> What other concerns are there for a person's well-being overall?

Yeah, I think again we certainly focus so much on the physical health of the person but I think we often fail to think about what's happening inside someone's mind.

What are the obsessive thoughts they're having?

What are the feelings they're having?

How much of the time are they focused on their weight or their body or food?

And so maybe on the outside they look fine.

Maybe their labs are fine.

Maybe Doctor says oh you're good, you know, but if that person is obsessing and just ruminating is the word we use over and over and over, maybe it's a really critical voice about themselves and what they're doing that is not someone who's going to probably be very healthy.

>> Right again might look or appear healthy but there's so much happening on the inside and so that might be another way that this disease shows up in somebody and goes undetected for a long time.

I also think, you know, just that spiritual realm and just kind of feeling bogged down feeling really, you know, weighted down.

>> I think that can be a big.

OK, here's a question for you.

The eating disorders we're talking about today, have they always been around since mankind in one form or another or have they developed in our recent history due to factors in the world?

Hmm, yeah.

I mean there's a lot of documents of anorexia being around.

I think a lot of times, you know, in religious settings with fasting there's some documents like early documents of people who took fasting too far and just ended up dying from that and but it became kind of this obsession and so kind of this idea of purity and so there are some some reports of that from long ago.

I think as we've gotten more food available to us, I think binge eating has become something that's maybe more common.

But I definitely think in certain cultures that's been present as well.

>> You know, back in the day of course, you know, with the depression years with the war years rationing and so forth, you didn't see people and of course when we're talking I'm not not trying to make a big deal about people being overweight but people rather rather on the thin side back then.

>> You know, those days and I guess we just didn't have availability of food as quickly you know, the fast foods weren't around the way people eat and so forth.

So it seems to me that those trends have changed and probably attributed to some of our eating disorders.

>> Would you agree?

Yeah, definitely.

I think I think just availability with food definitely can impact someone.

I also think to certain areas are food deserts right now where people can't don't have access to yes.

You know, maybe nutritious foods or foods that they can afford or cricket easy foods because working three jobs.

And so I think that's another piece that we have to keep continuing to look at and make sure that, you know, there's food equality for people because if you don't have access to foods then and healthy foods, you know you do your best to just eat.

>> Exactly.

Exactly.

And for some people if there's nothing else to do, let's eat.

You know, it's it's a it's a boredom kicker, I guess.

And we have another call Rosano is on the phone.

>> Rossana, you have the floor.

What is your question for the doctor?

I'd like to know if you burn more calories than you eat.

>> Is that the way you lose weight?

That is a very loaded question and I think you know, in some ways yes.

And in some ways maybe no.

I think you have to you know, metabolism is a huge piece and I think sometimes we we want to oversimplify it.

I also think, you know, if someone's under lots of stress your body is going to produce a lot of cortisol and that's going to impact, you know, the way your body is processing things.

And so I think in some ways yes, some ways no.

I think a lot of times the eating disorders that we really look at again weight loss often is not something we're focused on because we want to make sure the person is fueled enough and fueled properly even with binge eating disorder, a lot of people can be undernourished.

That's seems crazy but you know, they're they're eating maybe in very disorganized ways and so finding more regular eating patterns that giving them a lot more balance.

>> Right.

And so to go back to your question, it's it's very complicated.

>> So yes, sometimes and no sometimes it's a physiological thing.

I guess another thing too is that I'm noticing a lot of studies here about children and not getting enough to eat.

You know, especially the children who don't have parents home all the time and depend on them to create their meals because all these food programs are popping up to make sure that they eat.

>> Why is it so important that kids get and of course I know this reason but I want to hear you say it to get that balanced diet was there really during their educational years?

>> Why is that so important?

Yes, I think if you think about, you know, a child or an adolescent, they are developing they're developing their brains.

They're developing their organs.

They're developing bones.

Right.

They're growing.

>> We see their growth chart and they should be growing, gaining weight, gaining height and so it's really important that they do get accurate like adequate nutrition both in terms of getting enough but then also right.

Trying to get to the best of the parents ability, trying to get a variety of different nutrients in them as well.

>> Well, it helps to keep them alert awake.

It's nutrition in the mind as well not just for the body but exactly.

>> Children actually need to eat very well.

Yes.

If we want them to grow up nice and strong and like they should and smart and so forth but I want to go ahead.

>> We've got a couple minutes left here.

Are any of these eating disorders we discussed self treatable?

Can you just grab a book and say I'm going to treat myself and take care of my anorexia?

>> I mean anything's possible.

Yeah, and I would say most of these really need a specialized treatment team because they are so complex and oftentimes a lot of times people can maybe fix the behaviors they're doing with food.

Right.

Maybe I can follow my diet plan.

Maybe I can you know, just try to start eating more stop stop eating as much.

So yes, maybe you can change that relationship with food to some degree but so much of the time there's so much underlying it.

It's like an iceberg.

Right.

You might be able to work on that top part of your iceberg but there's so much underneath and it's unique to everybody and so I think that's where it takes highly specialized team to really consider what's happenig to the person, what's le them to this place and how we get them to this place of health.

>> Exactly.

Now for those watching right now and considering what maybe I need some help or maybe my loved one needs some help before they make a phone call to the family doctor or to a psychologist, is there a good website for reference to check things out and maybe weigh things out before you do that?

>> Yeah.

So I really like to route folks to the National Alliance for Eating Disorder Awareness.

They're a national nonprofit organization and they have a whole section that's just referring folks to treatment all across the United States.

>> Oh good.

Good.

And so they have a website they and that you can go to and you know, filter in or out certain things to find providers.

You can also just call them if you feel stuck and want some support and they are great at helping identify place say it again in the National Alliance for Eating Disorder Awareness.

>> OK, thank you Dr. Laura OIR thank you so much for being here.

We really covered a lot of territory as far as eating disorders are concerned.

>> Hope to have you back again.

Great.

Thank you so much.

Thank you.

Next Tuesday seven thirty right here we'll discuss hearing loss in some hearing loss solutions.

Well, our special guest Ted Blanford Jennifer Blomquist will be here to host that show until next time.

>> Thank you for watching and good night.

>> Good