Ann Coleman: A little heads up  – this episode is about eating disorders.

Although eating disorders didn’t officially make it into the DSM until a few decades ago, they’ve been around forever.

Scientists believe there may have been various reasons for the disorders other than the concern over body image, but the issues certainly existed long before modern times.

It wasn’t until around 1980 that eating disorders were associated with body image and the overwhelming desire to be thin – to look like the ideal beauty –those appearing in Seventeen magazine – like Brook Shields, Phoebe Cates, Cindy Crawford – definitely not a concern of the ancient Greek emperors who would gorge themselves then stick a feather down their throat to make room for more – just because they could afford to.

I’m Ann Coleman and this week on Speaking of Teens; Teenagers and eating disorders – what you can do to help prevent them and how you can help if they’re already caught up in a disorder.

It was the 1960s. There was the Vietnam war. Urban Riots. Civil Rights marches. Church bombings. Women’s Liberation. The Moon Landing…and Hippies.

For Dr. Marcia Herrin, who grew up one of 6 kids on a Montana ranch, the allure – the appeal of being a hippie was just too strong, she left college and at 19 moved back to Missoula.

What do you envision when you think about the whole counterculture movement – the hippies? Maybe Woodstock, marijuana, free love, the literary beatniks.

Well, for Dr. Herrin, hippies equal…nutrition.

Marcia Herrin:    And, and it was a pr Oh, it was such a wonderful time. You know, it was the late sixties and the women's movements and there was, you know, being skinny and blonde wasn't cool. God. And, and I, I became a hippie and, um, this guru came into town and said, this is in Missoula. And he was doing, we were all doing yoga and he was pulling a community together and he said, there's no place to buy.

Whole natural organic food in this town. And then he left. And so we raised, uh, we had a baked sale. Who knows what we sold, but we, um, raised $300 and a core of us, basically three of us stored this little store. We called it Mr. Natural's Good Food Store. It was in literally a closet, no bathroom. Your shift was as long as you could hold your Pee.

We made it nonprofit. It is now called the Good Food Store and is making millions. There's no Whole Foods in, um, that part of Montana thanks to this store. And, but here I was, so I'm 19, a college dropout. You know, I got brown rice into town and honey, and, and I'm kind of amazed at all the different ideas that people come in about nutrition.

And because I'm standing behind the counter, they think I know something.

I know nothing and I, but I want to know everything. And I was f you know, it's such a different time. Maybe because I grew up on Montana Ranch, I actually didn't know that you could study nutrition in college. I wouldn't have had a clue either.

And I went back to school and, um, boom, boom, boom, boom, boom, boom, boom. And the doctorate from Columbia University. I'm interested in the facts in science. Um, and there's so much misinformation. I remember said grandmother said, Marcia, you sure you wanna go into nutrition, people are gonna, it was hot then people are gonna lose interest. Haha. She got that wrong. Oh my gosh. She was right about a lot of things, but she was wrong with that

Ann Coleman: Sweet grandmother.

Something else Dr. Herrin’s grandmother really didn’t understand was that Marcia had anorexia, which may have been why she became so interested in nutrition and went back to college with a real mission. Her grandmother had taken her to the doctor, of course, but the doctors back then really didn’t know much at all about eating disorders - and this one, well, he didn’t even follow up.

And when she returned to college, she did start eating again…

 

Marcia Herrin:  : Um, bulimia hadn't been invented yet. I could have been famous. I tell my patients for inventing it, it never crossed my mind and um, I'm sure I would've experimented with cuz I went off to college and. Literally gained 50 pounds in the first semester. Half of that I needed, cuz it saved me from anorexia cuz I had no treatment.

but my brain could work cuz I was eating and I was so lucky to fall into this world as I was telling you about where there wasn't judgment about being, uh, bigger. So I became a binge eater . And then I fell in with these people that ate normally.

They're so wonderful. It was all about the spirit. They didn't Yeah. They're other worldly people. Yeah. Wow. Now, were they, is this the hippie group or is this a, a This was the hippie group. Okay. Yeah. I knew Bob from yoga and Judy, I met in Women's Liberation Group, and then they became a couple, and the three of us were kind of a threesome.

You know, I tell my patients, it actually, it was such a gift to me to be in that little bubble, which didn't last. I know that. And it helped me recover. Right. And I had to go through a period where I was bigger than I naturally am. I'm from kind of an embarrassing, thin family. I'm, by far, I have these.

Four sisters. I'm by far the biggest, well, we're all Wow. Just naturally very thin. Genetics. Genetics, genetics. Yeah. On the body size. Yep. But I wasn't thin there and it was such a gift. Cuz actually I might not have been taken very serious as a skinny. 20-year-old.

Ann Coleman: Well, you know, how, so how do you think that, you know, I've, I've read a little bit and I understand that part of the, the eating disorder, the whole eating disorders thing is part of it's genetic, part of it's psychological, part of it maybe medical, you know, social influences and all that. But what, what do you think, have you thought about yours enough to understand where the anorexia and then where the binging, because I, I was kind of surprised when I read you were anorexic and then you went into binge eating and then I. I was anorexic in high school and I went straight into binge eating and then throw it, you know, eating half the box of cookies and then putting the rest under the sink and running water over 'em so I couldn't eat the rest. That was creative, don't you think?

Marcia Herrin: Desperate. Yeah. Oh, I do. Yeah, actually.

Ann Coleman: So how, how do you think that happens?

Marcia Herrin:  Well, they're all connected and you know, the truth is, anorexia will kill you or severely impair you. I, um, work with adults who have not recovered from their anorexia and, um, Oh, it's, it's so tragic.

They're, they're physically disabled because their body's failing. The typical thing is you live in your parents' basement, you've lost your career. Maybe you graduated from college, maybe you didn't, you don't have any relationships, cuz the eating disorder is first and in one case, your 88-year-old mother is caretaking for you.

Now is that a strange picture? so, if, if it doesn't kill you, you have to morph into eating. And if you don't have anyone to help you do that And that's my role. I wanna prevent all of those negative outcomes. For my patients. Um, that, that's hard because humans, you know, we're designed for feast and famine, and we don't have much protection against overeating because our, we never had that opportunity until recently. So, eating as much as you could whenever you could was what we were all programmed to do. And every, so we, we have very little, um, natural, um, limitations to over, to overeating.

Ann Coleman: At the Geisel School of Medicine at Dartmouth, Dr. Marcia Herron teaches future medical doctors about nutrition and eating disorders. The founder of the Dartmouth College Eating Disorders Prevention Education and Treatment Program and Fellow of the Academy of Eating Disorders also runs a busy private practice in New Hampshire specializing in kids and adults with weight issues and eating disorders.

Ann Coleman: Dr. Herron, it's wonderful to have you here today. I thought about starting out asking you seriously about, you know, what are eating disorders and describe them, but actually I think it might be better to describe what normal eating is because I think so many of moms, and so many of my listeners probably have this weird relationship with food, or I'm assuming because I do. That maybe what, where we wanna start is what, what is just normal, a normal relationship with food? What does that look like?

Marcia Herrin: You know, that's the great question because I would argue that probably a sixth grader could give you a decent definition of anorexia and bulimia. At least people just know that maybe you and I didn't know that when we were that age, but it's well known as kind of a joke.

It's, um, et cetera. But normal eating. What is that? That is the. Question because that's where whoever you are on the spectrum of eating disorders or not normal eating is what we need and want to do, cuz it's normal. And it's really hard because we we're not designed for our food system, how it's evolved.

We're designed for, as I was saying at one point, feast and famine. And we're designed for, um, taking the whole clan, the tribe, the family, all our work and effort, our career is basically providing food for us. Whether it's growing, raising, chasing down animals, um, caring for animals, roasting over a pit gathering, forward gathering nuts.

It was, and you know, it's interesting, people didn't snack then because they didn't have time and there wasn't a, you know, well sure there was an apple way up on that tree, but you're supposed to. , gather a bushel of them and bring them back to the family. So it was all very organized and it's very clear across the world.

If you look at how people eat, they eat three times a day. they do. And you know, if I sometimes say to my patients, if we were zoo animals, that would be the um, instruction for the zookeepers. This species needs to be fed really nice amount of food three times a day and then make sure they have water and have a place to go to the bathroom.

But that's it really. And maybe you pet them once in a while cuz they like interaction . So it, so number one, it's eating meals and it's eating three times. Now there are few variant people, they're more likely to be male that do perfectly fine not eating breakfast. Most women are blood sugar contr. It just doesn't work.

And there's been some study on that. The concerned kind of, here's where we talk about science, what logic would say, and we've thought this, that if you didn't eat breakfast, you went for a long period of time without eating, your metabolism would go down and make it more likely to gain weight.

Oh, I love science. Where they, they took people and they crossed them over and fed one group, um, three times a day. The other group, twice a day, same food, basically. Same calorie, same nutrients. And the result, um, on health and weight was exactly the same.

Ann Coleman: Oh, wow. So that's good to know. That is good to know.

Ann Coleman: It, I have always just looked at friends of mine who seemed to be able to just maintain a constant weight mm-hmm. and just eat a little of this and eat a little. And I see them eating things like they'll eat some ice cream or they'll eat, you know, they're eating hotdogs or how, and I'm like, how, how does that happen?

And they just, they don't get fat. And they, but then I'm going after the big bag of York peppermint patties at midnight and eating 20 of them about those two Yeah. Before bed. And so, you know, it, it's just all that normal eating thing has eluded me.

Marcia Herrin: So here's the, here's another piece of normal eating that's really important that has dropped away.

So I've confessed that. I grew up in the fifties, right. Where, where people really didn't worry about their nutrition. Right. And, and we had, as a whole, people across the world were smaller. Right. So how did those people ate? They ate three meals a day and they had dessert with lunch and dinner.

Ann Coleman:  I read where you said that, that including the dessert is important

Marcia Herrin:  because it's one, it's the only thing I've found to keep us from overeating at meals.

My grandmother knew this. I wish she'd been alive so I could have said, I didn't know how brilliant it was. Okay, kid, save room for dessert. And so this was a big ranch. Two of her sons, um, ran the ranch with their father and each of them had six kids. So there were 12 grandchildren. If you can imagine.

People didn't overeat. You had your dessert. We humans naturally crave sweet and salt for some biological reasons. Did you know that there's nothing poisonous in the world that tastes good, that's plant or natural.

Ann Coleman: Really? Well that makes sense

Marcia Herrin:  If it's tasted sweet, it was safe to eat. Right. And sodium is an essential nutrient. That salt. that's not well distributed in nature. You know, you've probably heard of animals going to salt licks.

Ann Coleman: Oh yeah, yeah, yeah, yeah. They give cows, salt licks, I think.

Marcia Herrin:  Yeah, they do. Yeah. Yes, we did. It was a big thing. You had a block of salt, literally right. So the animals have to like, including humans, like salt well enough to trek to the salt lick. So we are programmed to like both of those flavors. And interestingly, if you listen to standard nutrition advice, it basically says don't eat sugar and salt.

Ann Coleman: Right? Isn't that something?

Marcia: Yeah, exactly. That's against nature. So it's just totally, totally backwards.

Ann: Um, you know, we were talking about, well I, I believe I did have anorexia in high school. I think I moved on to binge eating, um, later on, I feel like.

Marcia: Which is very natural. It's very natural in your body's perspective. There was a huge famine. You lived through it. You're one of the lucky ones. And now you live in the land of milk and honey girl, there could be another famine coming. You better eat up .

Ann: That's how I've, I've felt my, my whole life is like, Ooh, I, I might not get any more of this chocolate. I better eat all I can.

Marcia Herrin:  And if you're dieting in the midst of this, it sets up that the famine actually is real, is real, and even worse.

Ann Coleman: Well let, let's talk about that. Um, I know there's a difference between, and, and I guess it's a, it's a difference of extreme maybe between disordered eating and an actual eating disorder. So how, how, what's the difference? And maybe, you know, tell us about how that disordered eating maybe moves on into a full-blown eating disorder. And then we can talk about the different types of eating disorders.

Marcia Herrin:  Yeah, and it may be just simply genetics. Um, there's been a just. a ream of research that's been done on the genetics of particularly anorexia. Cause it's so easy to study, it's so clear. That's anorexia. Um, and has been around for so long. It is a genetic disease. Um, epigenes like the genes that, uh, are associated with alcoholism. Hmm. If someone never took a drink of alcohol, they wouldn't know they had these genes.

Ann Coleman: That's So epigenetics.

Marcia Herrin: Yeah. Alcohol turns on the In the case of anorexia in particular, we know more about that, which really offends people with the other eating disorders. Why don't we get the same occasion , but, and they're right. They're right. Um, but what turns on the genes is weight loss. Weight loss for any reason. One of my patients several years ago said to me, you know, hello teenage girl. Um, tell me your story. She says, well, Marcia was like this. I got my appendix ruptured. Got infected. I was admitted to the hospital for three weeks. I walked into the hospital without anorexia. I walked out with full-blown anorexia because she lost weight.

Ann Coleman: Oh my gosh.

Marcia Herrin: She didn't mean to, it had nothing to do with anything, um, that she was doing it, the weight loss. So you couldn't, um, it can be triggered by being sick or, you know, any number of things. Switch, just switched it on. Switch. And you know what's cool when you get people back to the right weight, it switches off like a faucet. Patients tell me.

Ann Coleman: That's unbelievable. Wow. Well, so, alright, so anorexia is the one that most people know most about. So what, what are the other ones? I know, um, it's in the DSM five. I think there's several now.

Marcia Herrin: So, oh, there's several. There's, yeah. Tell us about the different ones, which. See no one everyone's, you know, our stories are kind of typical.

No one starts with the other eating disorders, binge eating and bulimia. They start with some variant of anorexia and it, it, we think it's genetics and personality type. What eating disorder you're going to end up with. The personality types are very different. We think the genetics are looking different.

And so it's the undereating, the dieting, trying to change your body, launches all the eating disorders. And which one you're gonna end up with really depends on, uh, Genetics.

Ann Coleman: So, so everyone actually starts out with the an with anorexia

Marcia Herrin: with restrictive eating, right. Some form of restricted eating, which is the, you know, the hallmark of anorexia.

Ann Coleman: Wow. And then you could end up with bulimia or end up with binge eating or, and

Marcia Herrin: as I, yeah, and the longer you stay in your eating disorder, um, even if you're mo you've had decades of anorexia, you're gonna end up with the other two because anorexia, frankly, unless it's you're on the verge of death, is not sustainable.

Marcia Herrin:  So, so I like to say anorexia almost. Killed me. Binge cheating. Saved my life. Thank you. Binge cheating.

Ann Coleman: Exactly. Okay. So, wow. All right. I never thought about that. Um, so, so when, when someone goes in to be evaluated and they're, um, you look at someone to try to decide, you know, do they fit this, um, DSM five definition of whatever that disorder is, is, is that really specific or is it just more subjective?

Marcia Herrin: No, um, you know, in some ways it doesn't matter cuz the treatment's the same. The struggle the patient will have in following treatment recommendations kind of indicates may, you know, kind of their personality type and their genetics of what they'll struggle with. Um, you know, when you think about it, anorexia is weird and, you know, I'm part of that community, I guess you could say. It's not natural to starve yourself. , that's the most unnatural thing. But you know, th this is cool. Genetics. So we think it served some purpose in more primitive times, actually all the eating disorders did. It'd be nice in the primitive tribal situation if, um, you had a couple anorexics on the tribe.

During famine. Um, it's amazing how functional people are for quite some time with undereating. much functional than they should be. Almost maybe even a little manic. but that would be nice Bec and there, and most people with anorexia, like feeding other people or was you know, they won't be watching cooking shows in those days.

They're, they actually, it's not that they don't like food, they're actually quite obsessed with it. And wouldn't that be nice to have someone on the tribe that oh, goes out and gets the food a set, serves it, and then buy everyone enjoy it. I'm gonna go get some more. That is, that would be great.

Ann Coleman: Interesting that you said that because, um, I, I've actually, I've had a, a good friend in the past who was obviously anorexic and was always cooking and delivering food Yeah. To other people.

Marcia Herrin: Oh yeah, yeah. Yes. Wow. It is very fascinating. And you know, in those times, as soon as the famine was old over, because there was no social benefit of being thin, right. The person would start eating again and boom, the anorexia would recede. And, um, You know, another interesting attribute for surviving famine, um, it, of course starvation really decreases fertility in men and women. You don't want a bunch of extra babies, right, during a famine. But once there's enough food and the person restores their health, fertility comes back, and often people don't know that you, wow, you recover.

Anorexia is horrible on the body, right? Affects every organism that goes along. The body recovers from it all. When you recover, except for one thing,

Ann Coleman: what's that?

Marcia Herrin:  Bones.

Ann Coleman: Oh yeah. Your bone loss, your bone density.

Marcia Herrin: Yeah. And, and part of that is, um, anorexia uh, bone density is for life. It's laid down when you're an adolescent and if you have anorexia, when you're an adolescent, you lose bone density, you're not laying it down. And then your growth plates basically close at the end of adolescence, which varies a little bit with the person, but certainly it's by 20 or 22 certainly. And then you're done for life. But the heart rate, you know, the low heart rate is often how people die actually anorexia their heart just stop speeding cuz on starvation just slows right down. That recovers almost immediately. The body's so smart that recovers first before someone's gained really hardly any weight, just eating better. Right. And you think, oh, why not the bones? Well, you know, in those old days people didn't live past 30 so what did it matter?

It had the body had to make some choices. That's my take on those.

Ann Coleman: Uh, so Well, and, and that makes perfect sense. So, and that's another thing I wanted to ask you about. I mean, most of these, um, disorders, do they actually start in adolescence or in childhood or do they Well start in adulthood sometimes.

Marcia Herrin:   It's very interesting. Um, anorexia has really been studied really since the sixties, the fifties, the sixties. And, um, it used to be, when I first started working in this field, that's why Dartmouth hired me to start a program. It was a college girl thing. Anorexia and bulimia. And the age of onset has just gotten lower and lower and lower.

And Covid pushed it even. Look, COVID had a huge impact on children with, um, increase in particularly anorexia and children. I was gonna ask you about that. So younger. Younger, younger. Wow. I think part of it, here's my take on it, I'm horrified about what kids are taught about nutrition in school, in grade schools, and in high schools.

They're taught, I'm trying to think who, what audience is this message intended for? Mm-hmm. maybe and would be cruel. Some 70-year-old man that doesn't have a clue about how to eat well. Maybe the message, you know, don't eat sugar, don't eat fat. Right. Don't gain weight. Um, you should eat lots of vegetables.

Um, eat all whole grains. Um, oh, and you should exercise a lot. Mm-hmm. and these kids, you know, during Covid, and I've actually had kids to talk to, cause I was working with them through this mm-hmm. , they said, you know, you know how everything got shut down, especially for the kids. They had nothing to do.

They got maybe, oh, maybe I'll become a vegetarian. Maybe I'll eat healthier. And usually parents, you know, compared to other things they could be doing, say, oh, isn't that sweet? And they wouldn't even be impressed. Right. Isn't that so sweet? She's eating so healthy. And, and people did cook more. Um, cuz there wasn't, you know, we, we weren't doing, we were going out to, we're going anywhere.

And there was a huge increase in, in the, uh, dec well, her increase just the number of kids and then the de decreasing age of onset.

Ann Coleman: Wow. So, over the years, the, the trend has been that the, the age of onset has gotten lower and lower. Why? Why do you think that is?

Marcia Herrin: I think it's social media. You know, it is amazing. Oh God, I know too much about it. I never look at it myself because it's too much like work. I'm curious. But these, the messages there and the kid, you know, they follow people who, and I have some patients that participate that. , you know, they, they're body positive, but they're skinny white girls showing off their abs.

Ann Coleman: Yeah, right, right. Body positive. Exactly. And you do see, yeah, I mean, I have seen influencers out there who are, you know, doing pretty good at showing this is how you pose to make yourself look, you know, skinny and beautiful and this is what I really look like. So there, there are some people out there I think, trying to help,

So since you, you've been working in this field for like 40 years, so did you see a, a difference and, and I, I was gonna try to go back and look at the research, but I didn't get a chance to, but have you seen a difference, like when the, um, smartphones came out, um, within a couple of years? Did you see the trend with the ages going down or was that possible?

Marcia Herrin: Yes, it's been gradually going down and then covid just, you know, sent it off charts. Might have a five year old even.

Ann Coleman: Yeah. Oh my lord. Okay. So really young kids. And is it really young kids? Is it more dangerous the younger they are to have anorexia?

Marcia Herrin: Well, like we were saying to bones, yes. And you might not re, you know, if you don't recover from the eating disorder really before you go off to college, the odds of you recovering go way down. Oh, wow. And the longer you have, uh, you know, it's somewhat arbitrary, we know that. But it looks like if you have your eating disorder for seven years, um, the odds of you recovering though, we never give up on anyone, goes way, way down,

Ann Coleman: Really? So seven. So you really try to get someone to the point where they're eating within that seven year of period at least.

Marcia Herrin: Right. So, you know, that leads us back to your really good question. Well, what's the difference between disordered eating and um, an eating disorder? Disordered eating is a dangerous behavior. You know, it's like your kid is starting to experiment with drugs. Do you just say, oh, well he's not an addict. Right, right. You, you, you should intervene. And the intervention is so simple. It's, they need to be eating three meals a day and they need to have desserts and, um, right. Well let's talk about that then.

Ann Coleman: Go, go ahead and, and tell us, I mean, what are the things that, you know, that should trigger a parent to go, okay, whoa, whoa, whoa, whoa, whoa, we, we can't be doing this. And, and what do they do? What do they say?

Marcia Herrin: Well, number one, no kid should be losing weight. Weight loss is contrary to growth. No matter what size your kid is. If they're losing weight, you should be worried about it.

Ann Coleman: So even if they're overweight, the sitting around playing games.

Marcia Herrin:  Yeah. The overweight is Well, and we can talk about how exercise doesn't have any effect on weight. Maybe that's another conversation at some point. Okay. Just to intrigue you. Yeah. Um.

Kids aren't supposed to lose weight no matter what their size. Kids come in a variety size. Some people are bigger. Some genetics. Genetics. Genetics again. Okay, so they should be growing on a, their curve. Their curve, no matter what their size, and [00:40:00] you want them on their curve. Now, kids that fall off their curve in either way, above or below, indicate that something's probably going on with their food intake. Way too much or way too little. And we kind, we treat them the same. Eat three meals a day. Ideally, oh my God, the family dinner is really important. Oh, did that go away in Covid? You would've think it would've increased, but everyone was, you know, not every family, thank goodness, right? But so many families. Everybody was doing their own thing with food, including the kids and eating in the room and on their devices. And including the parents.

Ann Coleman: Oh, well, yeah. Okay. So you said something interesting. So, so really it's about your child's curve. So if you have a child who is overweight and but they've always been on that side, then that's, that's nothing you should be worried about. And eventually it will even out

Marcia Herrin:   Overweight is, overweight is an arbitrary how? Well the categories that we call overweight mm-hmm. , um, are totally arbitrary. Okay. And they're actually based on kids from research on kids, demographics on kids in the 1970s. Now I grew up on a ranch. As animals get well fed and you have generation after generation, they get bigger cuz that's, kind of biology get bigger, stronger, smarter, taller.

So it's no surprise that kids are bigger Okay. Than maybe they were And size runs in families.

Ann Coleman: Right, right. So generations ago. Well, and it, I, I think generations ago people were shorter too. and, and so we've gotten taller. We've gotten bigger, taller, bigger. Right, right. Okay. Right.

Marcia Herrin:  They have, they have. And the idea to turn that into a problem, um, childhood obesity problem, um, and the solutions that are suggested, um, co are very, could cause eating disorders and low self-esteem, increased risk of suicide, uh, to go on and [00:42:00] on and on. Um, I have worked with so many kids. It's so sad. Um, so here's a typical scenario. So girl is overweight. Doctors talked to the parents, well, you gotta do something. So she's not allowed any desserts or candy. Her brother is skinny. That can happen. Mm-hmm. , because, you know, unless they’re identical twins, they can be really genetically quite different.

So he's allowed this and that. The parents come and bring her to see me when they go out to their second car and realize in the garage that she's been out there eating candy and leaving the wrappers. Oh wow. And the poor kid is deprived and it's not fair. Right, right. So, the solution then, and you kind of hold parents' hands, okay, we need normal eating here. So there's no drive to overeat. She's deprived when people are deprived, um, emotionally, psychologically, or physically from food. You, you're gonna go for it. Yeah. If someone says, you know, there's this classic psychological, [00:43:00] um, experiment where you fill a room with all the latest toys mm-hmm. . , you put one little old beat up, red dump truck in there and put a kid in there and the researcher's watching from, uh, you know, they don't, the kid can't see it.

Right. And they tell the kid they can play with anything they want except the red truck

Ann Coleman: and they go straight to the red truck. Well, it's like trying not to think of something.

Marcia Herrin:  Right. Right. You tell kids you, you can't eat candy, which also seems unfair. That's what they're going to want to do. And they hear that message everywhere. You shouldn't eat at McDonald's. I want my patients to be able to eat well at McDonald's.

Ann Coleman: So, so really? Oh, well I guess I did it for a long time. . I did, but I did the milkshakes and the large fries. Maybe that's not eating well at McDonald's. I don't know.

Well, you have choices with sizes at McDonald's, which is nice. True, true. Well, so, so, and if you knew you could have go to McDonald's on a reasonable schedule, you would know reason to do the big, it's only when you tell yourself you're never doing this again. That exactly you do. You would be smart to do big.

Ann Coleman: Exactly. So, so what I'm hearing you say then is deprivation is, is really what leads to eating disorders a lot of times.

Marcia Herrin:   Yes. Yes. So, yeah. Almost always.

Ann Coleman: So telling parents to chill out and let the kids eat what the kids want to eat anytime they wanna eat.

Marcia Herrin:  Well, except, except what does that, that we don't say that to kids much about anything, do we?

Ann Coleman: Yeah. Okay.

Marcia Herrin:   Because they're kids. Right. Kids should be in the perfect world, they would have three meals, um, prepared and overseen by adults, and they come to the table and they're eating in an organized way. Mm-hmm. snacks shouldn't be random. You know, the perfect world, it's gonna sound like the fifties a parent, we won't say which parent is there at the door. The kids gets off the bus and here's your nice little snack. There's a glass of milk and a peanut butter sandwich and some sliced apple. Eat this. And, um, oh and dinner's gonna be served in two hours and the kid eats that and they're done. Right. You know, you kids come home to an empty house and there's all sorts of tasty snack food around.

No kid is gonna go make themselves a sandwich when they're 10 years old. Exactly. Or even 16 probably when there's this, that and the other thing that's really easy. So do you, do you advise people to like, have rules say no snacking before dinner, or we're gonna have the snack, like you said, you know, we're gonna do a snack after, after school, and then No, you're not going to the cupboard after that.

The best rule is to make it happen. And these kids need to have the foods they like, including the snack food, they like, um, work into their plans so they're not deprived of it. If they can only eat snack food by snacking, then that's, they'll snack. Okay. So I call desserts fun food.

And for many people, for me it's usually a dessert, a classic dessert or candy, but it's food you eat for pleasure. So it could be potato chips. Maybe, uh, parents send the kid off with goldfish and, uh, checks mix in their lunch as their fun food.

Ann Coleman: Okay. All right. So it, you know, and I tried to do this when I was raising my son because I knew I had such a problem with food growing up. And I heard my mother. every time, you know, every time she ate. Oh, I shouldn't have eaten that. Oh, I ate too much. I wish I would quit eating. I don't need to eat that. I heard that all my life growing up.

Marcia Herrin:  No wonder exactly. You didn't have a good relationship with food. Right.

Ann Coleman: And every time I turned around, she was eating pears and cottage cheese on a bed of lettuce. And I'm like, oh my God. So, and I was not allowed to eat chocolate because I was supposed to be allergic to it. So I was deprived of chocolate my whole life. And I would snake candy bars at my grandmother's diner and take them into the bathroom and eat them.

Ann Coleman: So that debt, that whole deprivation thing, I decided when I had my son that, you know, what we're, I'm not gonna make a big deal about food at all. I'm gonna keep my mouth shut, shut about food, about my own food, about his food. And he's never had a problem with eating. I don't know if I had anything to do with it or not, but he, you know.

Marcia Herrin:  Well, I think you did. I think you did.

Ann Coleman: Hopefully maybe I did something right. But, um, so it, it, you know, I know mothers we're, we are the worst. We're usually the culprits. We're the ones who diet, we're the ones who say things about our body. We're the ones who, you know, obsess over these things. So what advice do you have for moms, especially probably moms of girls? What do we need to be aware of, um, and what do we need to do and not do to make, to try to ensure that our daughters don't pick up what I picked up from my mother?

Marcia Herrin:  Well, you, you followed my advice as a mother. Keep your mouth shut Ah, about these things. And, you know, serve reasonable meals and so the kid isn't hungry and has an organized, healthy way of eating. That's good. And there needs to be fun in it because we live in a world of fun stuff, food-wise. And we don't want the kid deprived of those things because, you know, I know, um, kid will go and get that food when they can.

I remember, um, my daughter was pretty six maybe or so, she had a friend over and we baked chocolate chip cookies and we gave each girl two cookies on a plate. And the one little girl she snuck back in and I saw her and she took more cookies. And now I'm embarrassed to say I actually entertained the idea that I should maybe tell her parents about that. And then I remember what I knew about her parents. They're both extreme dieters. Oh, of course she stole the cookies. I never, I kept my mouth shut. And giving kids advice about nutrition is not a good idea. I have this basic rule that I learned from watching families, particularly when I was seeing families in my office. Parents would start launching into a nutrition lecture, which was kind of odd, I thought since I was right there, uh, and the, but the kid would just, you know, their eyes would roll. They, oh, here they go. It sounds like nagging to the kid. I could say pretty much the same thing. The parents weren't wrong and the kid was, oh, yeah.

Ann Coleman: So I, I learned, and I've tried to practice this. Don't give advice unless. . And I think that's, believe it or not, good advice for parents on everything, on every subject really?

Marcia Herrin: Pretty much. I, I think so. Yeah. Because otherwise they're not gonna be listening right now. It is true. As my adult children now, when, when they call and say, I'd like your advice, mom on something, I get a little excited, right?

Ann Coleman: Yay, they need me. Yay. You still have to be careful about what advice you give probably. But you know, at least they've asked, right?

Marcia Herrin: Yes, yes. But, um, it's better to model and make eating well, which as I think you're picking up, doesn't mean that you never take your kid to McDonald's. You go and have, okay, have some protein, uh, the french fries are my fun food or milkshake and, um, or Chinese, you know, lay it. It's all, all that's, we want kids to be able to eat normally for meals. So that would be a meal, not a snack. Right. Um, having the desserts makes a huge difference.

Ann: So adding those desserts in, not making a big deal about dieting, not making a big deal about what they're eating, not making a big deal about them being, um, underweight, overweight, unless you see that that's off their normal curve. And then maybe, yeah, there's, there's a problem if they're, if they go way too far up or too far down off what their normal right body is,

Marcia Herrin: and actually the going down is more dangerous than the going up above the curve. Now one of the things that happens important for parents of girls, they haven't, you know, and the other thing, um, we're seeing more and more boys with eating disorders, right? So because you have a boy is not, um, a pass, right? Um, and they're sensitive to these. Uh, it's so sad, um, that boys now feel. Many of them, much the same pressure girls do to be on the thin side. Insane.

Ann Coleman: No, I, I heard somebody say actually the other day that the little boy, the superhero costumes that my son had had, you know, when he was two 20 years ago, that now, you know, they used to be just plain little, uh, polyester things.

Now they have built in abs, so it looks like they've got a six pack. So, I mean, what kind of me, so we're sending the same message to boys message to boys, yes. That we're sending to girls.

Marcia Herrin: And of course, the only people that get hired to be movie stars are people with. abs. Mm-hmm. showing. I like to, I sometimes point on to my patients who say, oh, I wish I had abs. You know, we all have abs.

Ann Coleman: Exactly, they're in there somewhere.

Marcia Herrin: They're not actually supposed to, they're not supposed to show, actually, that means you're underweight or you're actually on steroids.

Ann Coleman: Yeah, exactly. And, and they didn't show back in the, the dark ages. Nobody had abs that were showing in the dark ages.

Marcia Herrin: Yeah. But they could still sit up. Right. They, they had no problem.

Ann Coleman: Um, okay, so, so we've talked about then how parents can really kind of help prevent these things. Um, so how, how does a parent know when it's time to go in and actually talk to someone about a child's eating? Like, what are the signs that, okay, this is, this is a little extreme or a and Yeah. Okay. Let's start there. And then maybe who, who should they take them to?

Marcia Herrin: So it's very weird for a kid not to eat a lot, isn't it? So if your kids Starts eating a lot less, I'd be worried if, you know, and the messages about healthy eating are so out there, oh, I'll only eat whole wheat bread. Or, or worse I not eating carbs. Right. Or, um, I really, this may seem radical. I think no child, um, should be a vegan or a vegetarian. Oh, it's safer if the parents are, know something about it. But we have these kids in meat eating families that wanna be a vegan and basically all it means, sometimes it's kind of a cover for not eating as much.

Ann Coleman: Oh, okay. Okay.

Marcia Herrin: And, um, it's, it's, I think it's too much to ask of parents and the nutrition is so important at that age, right. That you want, um, if you wanna, I say if you wanna be a vegetarian, A vegan, if you don't mind taking supplements for the rest of your life. Consider it when you're in college. Right. When, when it's really up to you and to ask parents to try to figure it out. Um, too much. Yeah. Too much. And it increases cuz it's unnatural in a case of a family where the, the family's not vegetarian, right. Um, the kid all of a sudden is thinking about what they should eat and what they shouldn't eat. That's kind of a setup for moving into an eating disorder.

Ann Coleman: So do you just say, Nope, we're not doing that. You're you're not going to be a vegan?

Marcia Herrin: I encourage the parents to Yep. Nope. Can't, you're not allowed to. Not in our house. Okay. Um, if you, you know, and do it when you're older if you want. Okay. When you move out and go to college. Kids have a lot of reasons. They'll say the, I'm doing it for the environment, animal rights. In college. You can do that. Then you can make a difference. [00:55:00]

Ann Coleman: And if you can't get them to eat, you know, they set, because, you know, it's easy for us to say, you know, no, you can't do that, but how do you force them to eat it? And then, you know, where do you go from there? ?

Marcia Herrin: Well, there's some irony here. And to preface this, I'll say a little bit about the standard treatment now for, um, kids who are living at home. Mm-hmm. is called family-based treatment. Yes. I was gonna ask you about that. Okay. It's changed the world. Okay. And basically, the professionals work with the parents and empower the parents and advise the parents and direct the parents to actually do the treatment.

It makes the parent the expert. And, and I back the parents up if they need a, you know, I'm advising them. But you, you'll, you may laugh, uh, about this, but still comes to question with a serious eating disorder, the kid I'm not eating how you can't make me.

Well, I remind parents that they control all their child's privileges. Everything. And in only one case when I asked, I'll say, whose phone is that? Actually , only one case. The boy worked at McDonald's and had a flip phone and it was his. Right. Right. But it's the parents. Right. And so, and we use this all over the world and, and this would be in a serious eating disorder situation. Um, you turn your phone over to the parent that's in charge of that meal. And you get it back if you've eaten to their satisfaction.

Ann Coleman: Wow. So, and that's not a problem. That's not a, I mean, you're not creating another problem to replace this problem?

Marcia Herrin: Well, what, what, what would be the problem? A child's gonna, um, have a hissy fit about their phone?

You know, it's funny. Parents worry about safety. not having a phone. Well, um, you probably raise your kids when they didn't have phones. Exactly. Um, and um, and maybe if you're really worried about that, it's just that they don't get it at night.

Ann Coleman: Right, right. So you just make it a rule like every other one. Yeah. All sorts of other privilege.

Marcia Herrin: Yeah. Yeah. And you know, it's funny, I, my generation, if your kids, if I needed my kids to do something, won't do, you know, they're acting out. You send them to their rooms. Yeah. These kids love being in their rooms. You can't do that anymore. And I, I may ask parents, and this is also telling of modern parents. I start with, well, what do you. , how do you get her to do stuff that she doesn't want to do? So there's kind of two answers. Uh, one is if the kid is the stereotypic genetic picture of anorexia, it's, she's the perfect kid. So it's, they've never had to do anything. Um, and, um, and often parents say, oh, we just give up.

Ann Coleman: Oh my gosh. So, so yeah. The tempera temperament then of a, the usual anorexic is the perfectionist and the good kid.

Marcia Herrin: Yes. Yeah. Oh yeah. So, and they're smart and they often. some recent stage show. I kind of love this cause I caught myself in their number higher IQs than average. And that's kind of cool. Um, but often I find that parents are almost intimidated by the classic anorexic child cuz she's often, it's a she mm-hmm. Doesn't have. Right. So perfect and so smart. Mm-hmm. and, uh, it, and they've never had to correct her on anything except, you know, now they're worried that she's refusing to come to eat dinner.

Ann Coleman: Wow. So, so, and she's losing weight. So when they take the, take the child [00:59:00] in and we use this family based well, so yeah.

Marcia Herrin: So the first step, and some of this is practicality, but also important, um, practicality, that pretty much you can't see a therapist or a dietician nutritionist without having a referral from a primary care provider for insurance to pay. But you, you want, you want the doctor to look at the kid. So the first step is take your kid into the doctor. Now, a lot of pediatricians don't know much about eating disorders. That's part of my role at Dartmouth. they're trained more to be worried about obesity so that the kid has lost some weight they might not be that concerned they should be. So the parent, if the parent's concerned, there's probably a concern. Trust your maternal, paternal instincts, I would say. Right. But you, you want, you want them to be checked out by the doctor and, uh, you know, if it's a serious case, that will be obvious.

The kid, Ooh, gosh, she's lost 10 pounds. Um, oh. And you tell me she's not eating and her period stopped and she's cold all the time. These are some of the, uh, classic signs or her hair's falling out. It goes on and on. Right. Um, The doctor probably will make a referral who's well known in the community.

whose expertise, um, in my community is often me because this is my specialty. Um, it can feel like you need, the kid needs to see a therapist right away. If they don't, if they don't have emotional problems and the therapist doesn't have any expertise with eating disorders, it's probably not gonna be helpful, frankly.

Ann Coleman: Okay. So a regular therapist is not going to be able to do much.

Marcia Herrin: Well, and Yeah. But the, you know, so the PCP is probably gonna know who does eating disorders. They're that prevalent. Mm-hmm. , who should I see? And with this family based treatment, I see the parents first. I don't wanna see the kid. Some kids I never see, I work directly through the parents.

So the parents are trained to actually do this at home, to do what they need to do with the child. , this whole, this whole approach mm-hmm. , um, started in Britain actually. Mm-hmm. , where they have, um, not very much outpatient kind of nutrition, eating disorder care. Mm-hmm. and the kids with minor eating disorder end up in high tech hospitals and it's costing the government a lot of money cuz they have universal healthcare.

So these group of researchers said, boy, what could we, could we do something about that? And they, they really thought and looked at what, what did they actually do in these hospitals? it's nothing fancy. They make the kids eat by having some consequences. Like basically you can't leave the hospital till you've gained kind of thing. And, that's it. So they said, could we teach the parents to do this? And they found out they could. The parents need support to do it. And, um, oh, it's changed the, it's changed my life. Well, I was already moving in this direction when this research came out, and I go, okay, here we go.

Ann Coleman: Confirmation.

Marcia Herrin: And it's really amazing that outcomes are so much better.

Ann Coleman: Well, so compare, I know, um, now your book, tell me again the name of your book For parents? Mm-hmm. . What is the. the parent. Well, you know, help me, dear God, with some fancy, cute titles, the Parents Guide to Eating Disorders.

Ann Coleman: Oh, that's good though. That tells you what it's Yeah, I know. So, in that book, does it, does it go into the family base and

Marcia Herrin: Yes, it does. Okay. It does.

Ann Coleman: So, so if they don't, because I find this more often than not, it's hard, especially in rural areas to find someone who, you know, specializes in, in anything in particular. So, your book could help if they, um, right.

Marcia Herrin: And, and there are other books on the family based. Treatment model out there too.

Ann Coleman: Okay. And we'll have the, the links, um, for you guys in, in the show notes. So we will definitely have the link to your book. Um, because I know, um, parents, you know, when, when you're sitting there alone and you have nowhere to go, it's terrifying. Um, when you don't know what to do, it is for your, for your child,.

Marcia Herrin: and this would be the question, the doctor may not know about family-based treatment. Right. But they refer you to a therapist you would wanna ask, do you, do you use family-based treatment techniques Do you know? And have you heard of it? No. Then I probably call someone else.

All right. Now, now let's talk about that. Stay on that subject. Because family-based treatment is not family therapy. It is not. All right. You might do that on the side in some cases though. That's a lot. Okay, so we're not asking them about, and that'll come later.

Ann Coleman: Family therapy. We're asking 'em about family based treatment for eating disorders.

Marcia Herrin: Yeah. F B T. If they don't know about it, they don't know much about treating kids with eating disorders. I wouldn't push a kid into standard psychotherapy. Especially if they're in a starved state. Unless they're really interested and really important that the kid ha like the therapist. to be able to tolerate them.

Marcia Herrin: All right. Um, I guess the one thing I would say, like any kind of behavioral problem, there's no reason to wait until it's so obvious that your kid has the problem. Right. Um, to intervene. . And with eating disorders, it's not a fancy intervention. Right. Eating well. Right. And, um, if you see a kid that's doesn't want to eat meals, doesn't want to eat in front of another thing that happens, not wanting to eat in front of people.

Um, in intervene there, because there's, that's, that's not, it's risky. And maybe it's just a phase, but who cares? The, the intervention really isn't dangerous. Eating three meals with your family when you can, um, okay. It's not really very dangerous. It's not like a, a whole list of side effects from a med I'm asking you to take.

Ann Coleman: Right. So, so the, the best advice for parents is just make sure your kids are eating the normal three meals. Have organized snacks. Yeah. Have dessert with meals. Don't make a big deal out of it. But as soon as you start, see, you know, little Susie says, I'm, I'm going on a diet. I'm not gonna eat meat.

Marcia Herrin: I'm not gonna do this. Yeah, yeah, yeah. You say nope. You're not allowed to diet while you live under my roof.

Ann Coleman: Perfect. That's great advice. Okay, Dr. Herron, thank you so much for sharing your expertise.

Marcia Herrin: This was really fun, Ann. I had a feeling I'd enjoy. I love it. I really appreciate it.

Ann Coleman: And, and I'm going to, uh, say one more time that Dr. Marcia Herrin's book, the Parents' Guide to Eating Disorders Supporting Self-Esteem, healthy Eating and Positive Body Image At Home is available at Amazon or wherever you buy your books. And Dr. Herrin's book for treatment providers. Nutrition counseling in the treatment of eating disorders is also available at Amazon if you'd like to peer into the clinical side of things.

If you believe your teen or tween or younger child may have an eating disorder, please take Dr. Herrin’s advice. Dr. Herrin’s practice is in New Hampshire but as a registered dietician she’s able to practice in many states via telehealth. You can find her at marciaherrin.com. I’ll also have links for you in the show notes for helplines in the US, the UK and Australia. Don’t delay in getting help. The longer you put it off, the more entrenched in the disorder your child can become.

You can go to neurogility.com /37 for this episode’s show notes and transcript.

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