- Welcome to "Teen Talk".

I'm Rhonda Herb.

Adolescence is an important time for young people to get a healthy start in life.

The number of children reporting poor mental health issues however, is increasing.

Building strong bonds and connecting to our youth can help protect their mental health.

Early treatment can help prevent more severe lasting problems as a child grows up.

To more effectively recognize the signs, Valley PBS has developed Teen Talk.

In partnership with local mental health experts and professionals, we're bringing the conversation directly to our school districts and our students.

Teen Talk gives our communities an opportunity to consider the importance of de-stigmatizing youth mental health issues.

Understanding the complexities of this topic and promoting dialogue with different schools will help you engage your own student bodies and foster meaningful conversations.

- [Narrator] Thank you to our Teen Talk sponsors.

Fresno County Superintendent of Schools.

Ascend Behavioral Health.

Balance Kids.

Learn4Life High Schools.

CalViva Health and Kepler Neighborhood School.

- Throughout our lives, we all experience times of concern about body shape and body image.

But for teens in particular, these concerns can lead to dangerous dieting and even eating disorders.

Eating disorders can negatively impact physical health, mental health, and all aspects of a person's life.

We're here today with a group of experts to talk about eating disorders, how to recognize them, how to understand them, and how they can impact our lives.

I'm Rhonda Herb.

This is Teen Talk on Valley PBS.

And thanks for watching.

Stacy, let's start with you.

Can you help us get grounded and understand what we mean when we're talking about the term eating disorder?

- Yeah, I think sometimes we can confuse some terms.

I think eating disorders is what we think about when we think more from the clinical perspective.

When we think about something that may be more casual to talk about, which would be disordered eating, those are two different things.

So when we're talking about eating disorders, we're talking about folks that are really struggling with habituated behaviors that really impact and interfere with their daily lives.

When we talk about disordered eating, we're talking about things that may be more on the outset of normal but haven't actually kind of crossed over to what we would clinically diagnose as an eating disorder.

We're talking about various things that might impact specifically intake, where they might be restricting their intake or they might be overeating in that way, and so that would be the binge eating that we do see.

There's also various forms of compensatory behaviors that come along with eating disorders.

It's kind of hard, I think, to kind of wrap our minds around it sometimes because it can look like a lot of different things.

It can really look like something that we might have normalized societally speaking, in terms of diet culture that we've been influenced by.

Social media plays a big role in different fad diets that are going on.

TikTok is kind of the latest that's perpetuating various... How do I say?

Sometimes abuse with food.

And so it just I think really depends in how you're looking at it.

But like I said, we usually are seeing it from the perspective of someone who's significantly impaired, is no longer able to live their life that is not only meaningful but kind of allows them to function day to day, normal kind of things that they might be experiencing where other folks that are struggling with eating disorders may not be able to do anymore, socially eating, going out with friends, not going out with friends.

So it really has a huge impact on someone's life.

- Dr. Christopherson, does this seem to be a problem that is particularly unique to teens?

Why do we have to be concerned about teens and eating?

- I think one of the biggest reasons that we're so concerned in adolescence is that commonly eating disorders are gonna start in adolescence.

It's really common for those disordered eating patterns to take hold at that time period.

And I think largely that has to do with what's going on developmentally when we're in our teenage years.

We're dealing with issues of acceptance into social groups.

We're dealing with issues of accepting ourselves.

We're trying to please all of the things that we think that we're supposed to be pleasing, whether that be parents or groups or teachers or coaches or even just ourself.

And all of that stress can become so overwhelming that we can lock into different things that give us the idea that we are making progress towards this ideal that we're looking for.

Whether it's a body size, whether it's a weight, like a number, or even if it's just being attractive or feeling attractive or attracting somebody that we want to engage in a romantic relationship with.

All of these things are coming to a crossroads in our teenage years.

- So eating is discussed.

It is a topic that you hear your fellow students talk about.

- Yes.

- Do you think they talk about it in healthy ways?

- Not necessarily.

They often talk about or they use words such as like this food, I don't wanna eat this food because it has a lot of calories.

Because now menus often have the caloric amount of the foods.

And so I hear a lot of people mentioning that they don't wanna eat certain foods just because they're seeing these amount of calories on the menus and stuff.

So I think that really has an effect on how we decide what to eat in social groups I guess.

- I think Riley makes a really good point.

We added calorie information to menus in the hope of helping people understand what calories they were imbibing, and it doesn't necessarily seem to have been as useful perhaps as we hoped it would.

So what's going on in society?

Do we think this problem is growing?

Is it getting increasingly worse and why?

- I definitely think it's getting worse.

I think it's getting worse for a multitude of reasons.

One of the things that I think affects more of the younger population is what it means to them to be doing things in the right way.

So there's oftentimes kind of a perfectionism that comes along with making certain food selections.

And if you look just specifically, if you were to evaluate things based on numbers, when we think about or I should say when somebody who has struggles with eating or feels overwhelmed with their choices and let's say their focus and their goal is to be as small as possible or to be similar to a friend as they can be in their shape or in their perception of themselves, they're oftentimes going to select something with a smaller value.

And that seems to be something that is much more revered than for someone who would be able to sit down and avoid seeing those numbers and making their selections based on those numbers.

So to your point, I do think there was good intentions.

Unfortunately, I think when you're looking at it from how it may actually influence decision, there wasn't maybe as much thought or time spent even to look at how that influence may play a role in how someone might feel about themselves making that choice.

- With our fixation now on calories and exercise and steps and all the ways that we try to measure health now, do we ever wonder what healthy eating is?

Do we know what healthy normal eating should be?

Is that something that people can talk about easily?

- I think that is a definitely difficult question.

What is healthy eating?

I think that probably people have general ideas that are pretty accurate when people think of balancing things with fruits and vegetables versus things that I bought from the freezer section.

And I think that people could probably make some pretty broad generalizations and get within the ballpark.

But I think that healthy eating is a complex thing because there's also a lot of medical things at play in individuals and there are a lot of genetic components to what a person looks like.

And yet what we look like is oftentimes what we're using as a feedback system for the foods that we're eating.

And so we might look at the calories on a menu and think, okay, higher numbers equals me looking like this in my mind.

And so one of the things that is intriguing is neurologically, our emotions and our psychology play an active role in our perception of the environment.

And so for those who are more susceptible to being emotionally activated by, for example, the number on the menu, that is gonna be...

They're gonna be hyper fixated on that.

Whereas people who don't really have any kind of thought to that or that's not something that they're really intrigued by, they're gonna generally ignore it.

And so the idea being, oh, we'll put this information... We'll require it to be on a menu so that everyone can make informed decisions.

Well, those who just need to make informed decisions won't pay attention to those numbers, and those who are using those numbers maybe in an inaccurate or inappropriate way are gonna become hyper fixated on those numbers.

And so that information neurologically may not be at all useful or even hit what the ultimate goal was because of the manner in which we perceive information and a little component in neurology that we call inattention blindness.

If we're not some...

If that's not important to us, we're blind to the information.

But if it's very important to us, we are hyper fixated on that information.

- Riley, have you had any health nutrition classes?

Have you had a basic understanding to help?

Do you think that students are getting basic information about what healthy eating really looks like?

- In especially elementary schools, I feel like the idea of the balanced plate is kind of put out there and schools generally try to create a balanced meal, like a lunch meal that they give students.

And sometimes they'll have posters on the wall that show you what a balanced plate should look like.

And I feel like this puts an idea into elementary school age kids that they generally don't follow because they're that young of an age.

So I don't feel like it has that much of an impact on them at that age.

- So we know that we're trying hard to get good information out for students and I believe schools are trying in cafeterias, and internet, you can find lots of good information about this.

Let's talk a minute about people who don't make healthy choices and how that sometimes makes us feel.

There are always special events.

There are always birthdays and celebrations and occasions for getting together, holidays and such.

And perhaps people do a really good job of eating and then something happens and they don't control their eating very well and then they end up feeling guilty about it.

The guilt probably doesn't help in any meaningful way.

So how do we teach people to have healthier attitudes about the choices that they're making?

- I think one of the things that foundationally helps a lot of people is actually having good nutrition education.

So having a fundamental understanding about why our bodies need certain foods and what our bodies need in combination of foods to be able to actually absorb things like macronutrients, micronutrients, and that's what I mean by specific nutrition education, is having a fundamental understanding of how our bodies function with nutrition.

There are two really wonderful dieticians who have really kind of come to understand what's called the plate by plate approach.

And they really fundamentally kind of go back to this idea that if you're able to make selections based on what your plate looks like, by having there be balance there with things that look good and sound good and are also nutritionally going to give your body what it needs, we're less likely to feel so concerned with that dessert item or that second helping or kind of it reduces that measure of guilt that we experience because what we're understanding about what we're feeding our bodies is that all foods fit.

That there are no good foods, no bad foods.

And once we can kind of take the judgment out of food, whether it's good or bad, you tend to be less reliant on your signals that say, do I, don't I?

Is this right?

Is this wrong?

Am I making the right choice?

And then we tend to feel less guilty about the choices we're making because we have an overall understanding that our bodies need all of these things to be able to function.

- Generally speaking, parents who are watching right now probably often have the question, how do we know when healthy eating is healthy eating and when disordered eating is disordered eating?

When do parents need to be concerned and what should they be looking out for?

- One thing I will say is if we look developmentally, then one of the things we understand about child development is that children grow in patterns and routines and they develop in a way that incorporates the values that they're presented as they're growing from birth all the way up.

And so one of the best things that parents can do to help their children develop healthy relationships with things like food is to try and pattern their own and model healthy relationships.

And so I would say that if a parent feels like they have an unhealthy relationship with food, try to find a way to resolve that.

Whether it's going and seeing a therapist, talking to loved ones or spouses about how you can help repair your relationship with food so that, that way when you're modeling for your children who are growing up, they're just repeating those same patterns and adopting those same values.

- So do we all need to go back to school and learn nutrition 101 all over again because I think a lot of parents struggle with this problem themselves.

- Yeah.

I think to kind of piggyback off of what Dr. Christopherson is saying, I think it really is about how you represent what food means to you, and more I think specifically how you use food in your day-to-day routine.

If you use food, for example, as a reward, you can start to then pass that on to your child unbeknownst to you thinking that you're doing something maybe helpful or treating in that way.

And we can start to condition ourselves to have certain beliefs or certain connections with food.

Something to consider too is how you're actually having conversations, the language that you're using around food.

So kind of not labeling things as healthy choices or better choices or good choices as opposed to does that sound good to you?

And becoming more intuitive in that reach for what sounds good.

And like I said before, kind of coupling that with I'm wondering if kind of we need to have more balance or if it would be helpful if maybe we incorporated a couple of these other elements, 'cause our bodies genuinely need these things in order to function fully.

- So, Riley, do you have friends that you think have disordered eating?

Have you seen examples of that among the friends that you hang out with?

- I definitely have, and it's hard to watch.

You obviously want them to have a healthy relationship with their food and you try to help them kind of build their relationship with their food when you see that something's going on.

But at the same time, it's really hard to try to intervene without harming the person more.

It's sort of a thing that you notice it's happening but there's not much that you can do as a person besides going to get help for them.

- Those are hard conversations to have and the other person may not be ready to open up and have that conversation.

Would you have any advice for teens, how to initiate conversations like that and how to steer people to the right resources?

- Yeah, I mean, I would say that when we are looking at having concerns about our friends, then really honing in on the idea that we're worried about them and we care about them.

The stronger the relationship over time, well, I won't say easier, the more effective it is at our words being able to be something that they can hear from a place of concern.

And so I would say starting that conversation with just reassuring them like, "Hey, I care about you.

Hey, I'm concerned about you.

I'm worried about you.

I want you to be healthy, but I'm just gonna throw this out there."

Another thing I would say, definitely take these problems to your parents.

Go to adults when you get really concerned because we've talked about a lot of complicated and very difficult conversations on Teen Talk like depression and suicide and eating disorders.

And like I've said before, the teenage brain's not ready to be able to problem solve these things in their social groups on their own.

Take this to a parent, take it to an adult.

Even if you're not ready to identify who it is that you're talking about, going to your parent saying, "Hey, this is the problem that I'm faced with.

I need help trying to navigate this," because a parent has been through lots of difficult conversations before and their brain is fully developed.

They're gonna be able to give a lot of advice that the teenage brain may just not even be able to come up with.

And so that is a fundamental thing that I like to encourage young people to do is go to some adult that you trust.

I think it's awesome that you said that take those problems to an adult because that is where you should take them first.

- So, Riley, your life is very different from your mother's life.

Do you think that there is more pressure on teens nowadays?

Does social media influence how we feel about our body image?

What seemed to you to be the strongest pressures that you and your friends face?

- Definitely social media.

There are a lot of people on social media who have what some people would call maybe an ideal body type or something that they are striving to kind of look like, a person that they wanna look like.

So they start... People generally start to change their relationship with food because they believe that if they wanna look like this person, maybe they need to start exercising more or eating differently.

So a lot of teens are kind of being influenced by these... Maybe the people that they're idols.

Sometimes they idealize these certain people and they decide that they kind of wanna change a lot of stuff about them or how they look because they wanna look like this person, and teens being very influential or they're being....

They're very easily influenced I'd say at this age.

So it's definitely a problem that is very common for teens.

- So the larger issue, the body image issue and the pressure on teens to look a certain way nowadays, do we see that problem getting any better?

Any reason to believe there's gonna be any hope out there?

- I think that there's always a reason to have hope.

I'm a very hopeful person but I also recognize that this not a new phenomenon.

Fitting in for our physical appearance, fitting in with our group, this is something that has been going on in the adolescent years and the young adult years for generation upon generation.

And so I think it's great that we have the technology to be able to put out things like Teen Talk and to be able to make information so widely available that I'm also really hopeful that as we work so heavily to de-stigmatize seeking mental health treatment, seeking intervention, seeking support, that that is helping people to recognize, oh, I can go in for a checkup in the same way that I can go in and talk to a therapist and I'm just kind of looking at, hey, I've got some things that I'm working on.

And the more that we work to not necessarily...

I don't like thinking in terms of de-stigmatizing mental illness as much as de-stigmatizing getting support for our psychological challenges or struggles that we're having, and so going to a therapist just the same as going to get our annual physical.

And as we approach that or as we get more ground in that, I think we are gonna see a lot more benefit from that investment.

And we'll have a lot more hope for kids being able to learn how to accept all the myriad of differences.

Because I think that if we look back historically far enough, then maybe body type and body size wasn't necessarily the thing that we were focused on in terms of comparison, but social comparison has been a part of the human condition for as long as we can go back.

- So, Riley, what would you like to say to adults who might be listening to this show in terms of the issues, the concerns that you and your friends have?

What do you wish adults knew and understood about the problem a little better?

- I'd say I wish adults knew that the influence that social media has on this new kind of generation of kids is so impactful and that the problems of eating disorders aren't as easily addressed, I'd say, as some adults may think.

Some think that this mental illness can just be fixed with maybe in a short amount of time, but depending on how severe the eating disorder is, it can be...

It can take many years to kind of reverse the effects that the disorder has had on a person.

And I think that many adults don't really recognize how impactful of a disorder that eating disorders are.

- Does anybody have anything you'd like to add?

Anything we haven't touched on that you'd like to make sure we covered?

Riley, can you think of something?

- The one thing I can think about is the effect that COVID has had on people with eating disorders.

Generally speaking, I'd say the amount of eating disorders, I don't know if you've noticed this, has risen during COVID.

A lot of people kind of developed these eating disorders because they were sort of isolated in their own thoughts and they had...

I'd say they didn't have control over a lot of things, but the one thing that they could have control over was what they were eating.

And so I think teens especially were really affected by COVID.

And one of the problems at that time was finding help, 'cause during COVID it was really hard to find therapists or specialists in this field.

Yeah, that's one of the things I wanted to bring up.

- Thank you.

- I think the only piece of it that I would really encourage is if you, yourself, are struggling with an eating disorder, to get the help that you need first so that you can be then a good model or at least a reflection of what a healthy or otherwise recovered individual might be like, therefore there's more of a recovery population that's out there to really be able to provide the support for those that are suffering.

Because one of the things that I found to be the most helpful is the amount of support that people feel when you can relate and really kind of not even have to say too much about what you're going through because somebody has a lived experience like that.

And so if you're able to find healing for yourself, you are a better advocate.

You are a better companion in recovery for a lot of folks.

And so just making sure that you're taking care of yourself if you're noticing some of these things are maybe resonating with you or you're affected by these things, to really seek services for healing for you.

And that gives other people, I think, a chance to kind of say maybe it's possible for me.

If I can see so and so do this and if I can see them prioritize themselves in that way and take care of themselves in that way, it might be possible for me too.

- Okay, I wanna thank our panel of guests today for coming down and being part of this conversation.

Stacy and Dr. Christopherson, Riley, thank you so much for coming out and speaking on behalf of teens.

And we thank you for listening to the start of this conversation.

We encourage all of you to have your own healthy conversations with your friends, with your colleagues, with your parents and teachers.

Keep the conversation going.

Thanks so much.

(gentle music) - [Narrator] For more information and resources visit our website at ValleyPBS.org/TeenTalk.

(gentle music) Thank you to our Teen Talk sponsors.

Fresno County Superintendent of Schools.

Ascend Behavioral Health.

Balance Kids.

Learn4Life High Schools.

CalViva Health and Kepler Neighborhood School.