150: How to avoid passing on an eating disorder to our child with Dr. Shiri Sadeh-Sharvit

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Hello, and welcome to the Your Parenting Mojo podcast. We are in for an interesting ride today because we are going to talk about how parents with eating disorders can navigate issues related to food, and eating, and body image with their children in a way that hopefully means that these issues are not going to be passed down to the next generation. And the reason this is going to be an interesting ride is due to something that I have mentioned previously on the podcast, so longtime listeners will already know I mentioned in the episode on raising a girl with a healthy body image that my mom starved herself to death when I was 10, and I've also struggled with less than healthy eating habits over the years. And I've been pretty conscious about this since my daughter Carys was born— she's seven and three quarters now that three quarters is very important. And just a couple of months ago, she asked me where my mom is—we have talked about this before so I'm not quite sure why it came up randomly out of nowhere and I told her that she died it was because she didn't eat enough. And Carys kind of looked at me and said, “Well, that's never going to happen to me because I love eating.” And so, I guess I'm doing something right. And so to help more of us along this path, my guest today is Dr. Shiri Sharvit. In her early career as a psychologist, Dr. Sharvit worked in an eating disorders inpatient unit and expected that most of the patients would be teenage girls, and was surprised to find a number of adult women who are navigating disordered eating along with child-rearing. And so she studied mothers with eating disorders, and published the results, and then worked with Dr. James lock at Stanford University to develop a parent-based intervention program. Out of that work came the book Parents with Eating Disorders, and Intervention Guide, which is aimed at therapists with patients with eating disorders, but it's short and very readable, and very accessible to a non-specialist audience as well. Dr. Sharvit is now the Associate Director of Training at the Center for Mobile Mental health at Palo Alto University and she also serves as the Chief Clinical Officer of Eleos Health, a startup in the mental health space. Welcome. Dr. Sharvit, it's great to have you here.

Hi Jen, thank you so much for inviting me.

I think the chronological beginning of all of this and where these disordered eating habits come from, what do you see? And then I'd love to sort of weave into discussions about some of the broader societal issues that I see as well.

So, you know, the term disordered eating, which also includes dieting and other unhealthy ways of referring to our bodies is an umbrella term for multiple unhealthy behaviors aimed to affect the weight and the shape of an individual. And, you know, they're among the most common risk factors for developing negative body image and eating disorders. And there isn't just one cause for disordered eating can say, you know that they occur because of one specific trigger, trauma, one comment that someone made unintentionally. The data shows that all psychological difficulties and struggles—they thrive in a cultural niche, where culture and the environment, our society creates the blueprint for the correct and “incorrect behaviors” and technological issues are expressed in regards to the dominant culture. And, you know, there's no surprise that when we think about it this way that our culture is so twisted and distorted in the way that it perceives bodies in general, and the female body in particular. And we know that it is really hard to block the ongoing messages that are very implicit and come from different angles. It's not just you know, you close the TV and you tell your daughter or yourself to avoid social media altogether, It's intertwined in our culture in so many ways. And I mean, in addition, there is this, connect that, again, marketing pressures and other cultural forces created between, you know, enjoying foods, enjoying your body, celebrating your femininity, and acts of moral and it says if you're a good person or a bad person if you can control your eating and our culture, it's fat phobic, and, of course, due to capitalistic reasons, our bodies are a product of consumption. I see this all the time coming at a very early age. I remember when we had, I am a mom of three girls, so you know, they affect me as a woman, as a psychologist, and also as a parent. And I remember when my oldest daughter, five years old, and one of her friends coming over off to kindergarten, and they had dinner with us, and then I offered them dessert and the other kid who was five years old said, “Oh, I know, if you eat a scoop of ice cream, you need to run around the block for 10 times,” you know, this was one of the times where I realized how these messages are penetrated into our kids’ brains and affect how personalities build from a very early age

Yeah, and I think one of the ideas that I want to pull through most clearly I think is there's some propensity within ourselves to perceive things in a certain way to react to things in a certain way, whether or not that happens and how that happens, happens within our family unit, which has its own history and interpersonal stuff going on, and also happens within our broader culture, which is very much set up as you said to prioritize to make more important certain kinds of ways of being in the world. And that if you are in the world as a slim White woman, then you are able to celebrate your femininity in a way that would be shamed if you did not have that particular physique. This is every level of our life—from in here, just me, there's nothing else going on here to the ways that I interact with the people around me, to everything that I see in the culture around me, what it's okay to display, what is not okay to display, what's being sold to me. I'm thinking about a Diet Coke commercial that I saw recently that was talking about how amazing your mom was. How she got so much done, right? Protestant work ethic, you just work hard, you'll be a great mom. Look at all the stuff you learned from your mom—Diet Coke, you know, you learned how to diet from your mom too. Don't you want to keep that going? Don't you want to be like your mom as amazing mom was? Have a Diet Coke is everywhere, isn't it?

This is a very sad commercial. I've been watching Dancing with the Stars with my 10-year-old daughter. She's a dancer and she only studies in schools, all my kids only studies in dance schools where you know, there was appreciation for diversity of bodies, and you know, neither the teachers nor the students felt underweight or looked underweight and it was very important for us as parents to have an opportunity to model diversity of bodies, and weights, and sizes, and shapes, etc. And don't count at all. And they don't affect how much you enjoy dance. Anyhow, we did watch Dancing with the Stars, my protestant part as a Jewish mom—feeling guilty for letting my child watch the reality show, but you know, dances are amazing, and you know, all the messages about the work ethics and how hard they work to get to where they want to be. There are great topics to communicate and talk about with my daughter, but you know, I had to tell her, “Look at their bodies. Their bodies are not realistic, they've had work done because a woman's body doesn't look this way and look at them. All of them look the same all of the women except for one,” you know, woman, the token participant with a different body size and shape and I told her this, for instance, she's a 40-year-old woman, she had three kids, a woman's body after giving birth doesn't look this way. And I really wanted her to know when she sees these women that it's not real, just you know, like she watches Avengers and she doesn't think that she could like jump from one place to another like spider man. Again, this is a work of fiction, seeing these bodies and I'm really sad you know that not all parents are able or feel like they have the freedom to communicate these messages to their kids. And also, you know, me and my husband we say that I am familiar with, you know, other messages that she subjected to outside the home, so it's an ongoing work. The messages?

Yeah, absolutely. And I think one of the reasons that I was attracted to your work is that it doesn't just focus on the personal solutions, it also expands this to involve the family in what's going on in addressing this challenge. Before we go there, I want to sort of briefly acknowledge the necessity of broader social supports as well, which I think too often we neglect when we're looking at disorders that we consider to be just within the person. And I know that you have seen, you've written about an imbalance between maternal stressors and maternal resources, and wonder if you can speak briefly to what you see the role of broader society, and our social structures in our healing from these kinds of issues.

I started this work prior to becoming a parent myself, but that then and even more, so now, I don't blame parents, we as parents are programmed from very deep evolutionary and fundamental reasons, to protect our offspring, to protect the young, and to be agents of the more general culture and society so that they will prosper in that society. And if I'm an individual who internalized the thinnest ideal, you know, someone received all their lives messages that, you know, they should control their bodies, they shouldn't enjoy food, maybe they should remove all excessive hair, excessive fat, maybe wear certain clothing, speak in a specific voice, etc. A good parent communicates the values that they perceive as important to their child, because they want the child to have the best tools to succeed in life, and have a very rewarding experience in life. Therefore, you know, it's not fair to ask families or parents to change in isolation to the general environment, they shouldn't be disconnect, you know, when I sat with my daughter and talk with her about Dancing with the Stars, or it could have been like any other TV show, the work is not done when I finished speaking with her, it's important, you know, that I as an ambassador of healthy eating habits, and self-acceptance would continue communicate these messages and try and change the entire culture.

Yeah, I think that's so critical to understand and to know that this is not just a thing that's going on within a person, and also, we need to have support from our broader culture as well. And culture is transmitted through parents, as you said, and so the way that we speak to our children has impacts, but also the way we are in the world and how we perceive other people, and what we criticize, and what we allow to stand, it speaks to what is normal in our culture—what is accepted, what is allowed and so we are agents of that culture in both directions, in terms of what we transmit to our children, and also what we allow to exist in our culture. The final thing that before we started digging into the research that I want to make clear to folks who maybe you're the partner of someone who has an eating disorder, and you're listening to this, or maybe you're like, “This has never been a thing for me, but I just want to make sure that I understand what's going on here,” is that eating disorders are not always about being thin. It's not always, “Oh, I see this amazing picture and I'm gonna stick it on the wall, and that's how thin I want to be.” I think very often, it's a perceived need for control. It's a lack of being able to have real connection between other people in our lives, and this is a method that people can use to feel as though they have a sense of control, to feel like everything else is out of control, and I can't talk to anybody about it and so I'm going to control this instead, and I know that was the case for me. My teenage years were absolutely miserable, and so, I thought, and it wasn't even a logical process that I thought through you know, this is something I put words to afterwards, but I think the process was if I just get thin enough, they won't see me. They will stop seeing me and they will leave me alone. I just wanted to articulate for folks who may be newer to this topic. This is not necessarily about I just want to be thin.

Yeah, absolutely. Well, there is a range of eating disorders. We have anorexia, bulimia, and avoidant restrictive food intake disorder, bulimia nervosa, binge eating disorder, most of them except for food intake disorder. They revolve around the issue of internalization of the thinnest ideal, that's clear because you know, that's the ecological social niche in which these disorders exist, but they also incorporate and include great amounts of psychological suffering. It's not just dieting it's much more extreme than that. It's sometimes the clients describe it you know, as the IV on the house feel like they're intoxicated their entire brain is “hijacked” by the eating disorder, and by thinking about what they eat, how much they eat, the control of their body or the desire to control it, their shape and their weight. And it gives a lot of new content that feels more under their control compared to life in general.

All right, let's talk about how this shows up in pregnancy in mothers. I'm wondering what patterns you see of how this shows up from pregnancy. And I think though I actually did pretty well in that period, because it felt like it had been the only time in my life when I sort of had permission, again, to feel “fat.” And I saw a stat in one of your papers saying that 29 to 78% of women achieve full remission during pregnancy, which really surprised me. But I imagined that it on the flip side of that can be a pretty scary time for some folks. So, what kind of patterns do you see showing up in the pregnancy period?

In my studies, many of the clients that I met, and in research, the average age of the eating disorder onset was 14 years old, although you know, I have clients and have had research patients remember that they started dieting at age six, and on average, they became parents at around the age of 28. So this means that the eating disorder for those with the more chronic course was well embedded in their personality, and even preceded their perceptions of themselves as young adults and adults. This mindset sits in your brain and in the way that you communicate with life and perceive and interact with the world, it's clear that you know, it will automatically carry also to the pregnancy periods. And on the one hand, people really felt you know, permission and legitimacy to eat, to enjoy food, but there was a lot of distress. One thing that was clear is that moms didn't want it to hurt the child so I heard from many patients, you know, that they were really calculating which meal they may be able to purge, so they started tried to eating the healthier stuff, as they you know, perceive it. And then if they ate palatable food, or foods high with sugar, or fat, and carbs, they would felt that it's okay to purge them if they'd eaten healthy food that the child or the fetus can enjoy. Most of them did not feel comfortable with their bodies and you know, you also attract a lot of attention as a pregnant woman—people comment on your body, sometimes people want to touch it, I feel, you know, I see that throughout all cultures, so I assume it's an evolutionary thing, you know, we've just tracked it to protect pregnant person. However, these moms didn't feel comfortable or happy times in their pregnancy, for many, it was really great time, or constant thoughts about how the baby would look like, how much would they way they be attractive or not etc, coming from a very early stage in pregnancy, and also, the mom's increased vulnerability, made her you know, want to attach many times to patterns that failed in the past like they reduced the stress and the eating disorder did serve as an unhealthy coping mechanism to many of these mums,

Okay, are there physical ways as well that it shows up?

So we know that on average, they gain weight less than women without a history of eating disorder. And they report greater side effects like compared to parents without eating disorders.

Okay. And then I think I saw in one of your papers, some mothers may arrive at childbirth with the depleted energy so a lower sense of self-efficacy and more negative emotion, so there are some for which this is a positive event, and there are others where yes, this is supposed to prevent maybe it's a one-two child, but there are definite challenges physically, mentally, emotionally, and how this shows up, and that we can get to childbirth being in a position when we're already depleted by this experience of just having been pregnant. And then I'm curious about what happens after the baby's born, we're in a real transition period, it's hard for any person to navigate this period. What kinds of characteristics do you see in the infants? Well as in the parents of infants, and how are those two related?

Okay, first of all, most of the mothers report honeymoon periods, with the baby and with their bodies postpartum where, you know, maybe because of being too preoccupied with the baby they had less time to focus on their bodies, maybe there's greater self-acceptance, more permission, even from the environment to not lose all the positive during pregnancy. I've seen all of them have really immense commitment to the child's well-being okay, I want to say that upfront. And in addition, there's a lot of distress related with breastfeeding. They don't necessarily breastfeed more or less but the thoughts of the company breastfeeding though, we all parents are unsure, especially our first child, if have they eaten enough? Is it too much? Is it do I want to feed them is okay? Maybe not enough and they're always you know, messages in the back of your head, these mums, the stress is increased, they report the transition to motherhood is more challenging primarily because this interaction of feeding one's child and not having the cookbook or the very explicit guidelines on how you know things should work are very difficult to, especially to a subset of individuals, those with you know, obsessive tendencies then the high need for control. And again, this is something that every parent is, you know, experiencing. If there's an eating disorder in the background, it exacerbates many of these difficulties.

Yeah, and we have this real strange cultural bifurcation of messages in infancy, right? Infancy is the one time when you look at a chubby child and you think, “Oh, that's the way it's supposed to be,” right? And then they get to a certain point and that chubbiness isn't okay, anymore. And I wonder if there's extra difficulty there, like, if I would look at a chubby child and think, “Oh, that's great,” society says it's great, or is it really great? There is a difficulty there around children who may be, you know, at different points in what we would consider “normal weight.”

Yes, absolutely correct. Many moms and parents in general describe heightened stress around how their child is feeling, how they're developing their hunger, etc. And to the extent that one of clients told me that, you know, she used to go in the mall with the trolley and the baby, and people would ask, how old is this baby, and she would lie, and say that they're actually older so that people won't say, “Oh, wow, what a big baby they lived in,” or whatever they would say, and maybe she would never receive any such response in the real world, but in her internal experience, she was fearful that people would judge her baby for their body, and that was you know when the child was four and a half months old. Yeah, and another person told us in group that her mother-in-law really appreciated every fats in her baby's body, this woman felt like she wanted to die, she thought it said that she's not a good mom, for not protecting her baby, again, read four months old, from the risk of becoming overweight.

Okay, and so all of this is sort of going on underneath the surface and meanwhile, we're supposed to be happy because we have a new baby, right? And I'm wondering if all of this contributes to a greater incidence of postpartum depression and other challenges related to parenting. Do you see that?

It's hard to tell if this is primarily due to the stressors of parenting with an eating disorder history because many of the individuals also have a co-occurring depressive or anxiety disorder. So, you know, in general, they're more vulnerable than the average parent, they also display amazing stamina and ability to parent their child and put their own difficulties aside, I don't want to, you know, highlight that again, and again, so that parents viewing this or listening to this podcast would have seen like they're doomed and they've failed as parents. I've seen parents really do their best to help their child and protect them from any negative effects of their parental eating disorder.

When I posted about this in our community, I think one of the things that came across most clearly was how do I stop this from making its way to the next generation? So, if we haven't sort of been able to consciously make a decision to stop this from going through to the next generation. What kind of shifts do we see as that child is getting older? And we're getting into issues around, we're in solid foods by now and we can see how much food they're eating, maybe they're having picky eating, or maybe they're eating everything in sight. How does that interaction impact the relationship?

Okay, that's a great question, because I think you really got it in here in the transition between the baby who's being 100% fed and you control what they eat and their food choices. And then you start having a toddler with some differentiation between you and them, and a child can have their own personality and their own hunger, and different fluids that they like or dislike. And here we really see many conflicts around mealtime—a heightened stress in the parents increased conflicts, often between the parents, especially if there's one with an eating disorder history and another without such history, and they're unsure how to help. This is a time where people mostly reach out for treatment right away. They don't necessarily know that there's such a thing as parent-based prevention, and maybe they can't really verbalize even to themselves that their history and their own perception of their own bodies affected their child. So they starting out to do pediatric dietitians or pediatricians, or other coaches, etc., instead of like reaching out to an eating disorder specialist because it doesn't feel like it's their own issue. It feels like it's their child's. And we see heightened anxiety about foods in all different angles, sometimes parents feel like they haven't had any like schedule or routine eating growing up, so they don't know how to instill in their child. Some parents feel low self-worth and self-esteem, and low self-efficacy as parents how do I a parent with eating disorder history can really engineer healthy eating habits in my family when I'm unable to do so? And oftentimes, they don't even have ideas for what to serve their children because they haven't had that experience often growing up, maybe because the eating disorder developed early and did not have a long enough history of eating healthfully with their families as a child.

Yeah, I remember one of the case studies from your book which was drawn from a composite of different people. But it's talking about the parent basically serve the same meal for dinner every night. Beans and broccoli and I forget what the other thing was, but every single night and the kids are an active rebellion. So, I'm curious about what children notice about all this because when I look back, I don't remember a lot. I know that memories show up in different ways and that is definitely possible. There are implicit memories buried that I am not able to articulate wow, I do remember occasions when my dad would be working late and we would be allowed to have sort of a special meal, which was spaghettios on toast, and my mom would eat separately, and I actually don't even know if she ate on those nights. I remember how much she weighed If she went over seven stone, which is about 98 pounds, then she was overweight by her standards but I didn't have any frame of reference for what that meant because I weighed, you know, 50 pounds at that time, so sort of a couple of things that stick out. And she weighed the breakfast cereal too, she got one ounce of the muesli that she made herself with no added sugar in it, and my dad got two ounces of it. But those are sort of really isolated things. So what do you see and how children notice these things and respond to these kinds of patterns that they're seeing in their parents?

Well, children, notice all these patterns. We unintentionally model behaviors to our kids—positive ones, and probably sub-optimal ones are the ones that we actually don't want them to observe, and they see everything, and they hear our comments, and they see what different people ate at lunch or dinner, and who's at the table, and who's just serving food. They identify the distress that parents feel, you know, they're very curious about us and what we're doing, so they can also often follow the parents to see what they're doing, and then, you know, we can observe when they become aware, too—purging or obsessive weighing, etc. So, unfortunately, they see everything and without having any other feedback, they assume that this is the correct way to address food, weights, and bodies.

Yeah, you reminded me of something that I read somewhere, and I can't for the life of me remember where but a parent said that she caught her young child standing over the toilet with the back end of a fork down her throat, and you know, what are you doing? And, “Oh, well, isn't this what we do after meals?” Right? Yeah, and just thought it was what we do after meals. So that they're probably watching. They are watching, they're probably noticing.

Yeah, because then you can sell us stuff to make that happen. Yeah, okay. What kind of outcomes do we see among children whose parents struggle with an eating disorder? I'm curious about both from an eating perspective and a broader perspective, as well.

Okay, from an eating disorder perspective, we do see there's increased internalization of the thinnest ideal, we see higher body dissatisfaction in kids as early as the five years old, we see a greater proportion of different diets from very early on. One aspect that you know, I don't think that I've mentioned so far is the flip side of the restriction, which is an intended focus on physical activity in the guise of health behaviors. I've had the pediatricians and dieticians telling me about kids, as young as seven-year-old arriving at the pediatrician with stress fractures, because they are on the swim team, and, you know, football team and the soccer team, and they work out so much throughout the day without giving their bodies sufficient nutrition, and we see driven exercise in kids starting at a very early age, and again, it's like the same thinnest ideal, but it comes back in a twisted way. No, it's not thinnest, it's athleticism. But it's this same issue altogether, so, I do want to highlight eating disorders can display the desire for weight loss, etc., which we all know, but it can also be associated with messages about health and physical activity, again, in the guise of health behaviors.

Yeah, and another thing I was, I guess I shouldn't have been surprised. But it was a bit surprising to me when I was reading through your work was the extent to which control shows up in other ways that parents interact with their children in things like play and the way that these mothers seem to be overall seeing their children as being more volatile, less positive, and that they were just struggling a bit more with parenting in general, can you speak to that a little bit.

So, in one of our studies either recorded parents with an eating disorder history interacting with their kids in open, non-structured places situation, not around eating, not around teaching, but just playing with them. And their research assistants who did not know which group this man belonged to evaluated the play scenes in the videos using the emotional availability scales, we realize that these moms are oftentimes average and everyone and all these moms have not been to treatment for you know, helping them become better parents. Okay, just want to mention that these data in general, not only in my own studies are driven from populations of parents who have not received the parent-based intervention or any other specialized intervention for parenting. This is three interventions and three support, but we did see greater anger expressed towards the children’s more controlling behaviors. These moms for instance, again, on average, as a group tended more to interfere their child's continuous play in comparison to women without eating disorders. And this heightened stress and sense of low parental self-efficacy, affecting you know, how they interact with their kids in many other domains, not just arena of food and eating.

Okay, so I wonder if you can tell us about parent-based prevention. What are some of the main theoretical contracts that it sits on and how does it work?

Okay, so this is really a study. A treatment that was developed based on my experience with these parents, you know, as I interviewed them and ran my studies as part of my dissertation, I really realized that they are inadequate or even non-existent in specialized interventions for them, and they kind of, you know, fall between the cracks, because it's not really something for nutritionist because there's not a problem yet. And, like, they know the rules, they read all the books, and on the other hand, that decision doesn't often understand they're experiencing. And what I realized very early on, is that change shouldn't be the responsibility of the parent with an eating disorder history, they should engage their partner or another person that can support them, we understand that these parents need a lot of support that is focused on the feeding interactions, reducing mealtime conflict, helping them accept and contain some of the uncertainty that is part of parenting in general, and give them more skills and tools that can help them in parenting with their kids and also making healthy decisions about their children's lifestyle. So, the treatment is well session the program both parents if their two parents or another support person participate in almost all meetings. In the first phase, we meet the parents, evaluate them, we educate them on Lean Centers’ Division of Responsibility, and feeding model, which says, you know that there should be some differentiation of responsibility—parents are responsible for what the child ate, when and where, and the child is responsible for if they're eating yes or no, and if yes, how much? And many of struggles and unhealthy processes developed when there's a clash between the responsibilities of each party. And of course, we talk about, you know, healthy eating habits, having three meals a day, and between two to three snacks, having all macronutrients in each meal, not skipping any specific food group, etc., including desserts and snacks in your regular eating, and allowing more room for flexibility. Part of phase one is the family meal, we invite families to come and have a picnic in the clinic and it's really a great experience, first of all, if you get to see the kids because I've mostly worked with the parents, and you know, it just adds another layer for me working with the parents, but also see all the transactions, what they talk about. They choose to bring, who eats and who doesn't eat at the dinner or the picnic that was supposed to be for the entire family, and the conversations that they have. And you learned a lot in identifying areas where you can intervene. Then in the second phase, most of the sessions are with the parents with the eating disorder history because feel like they need some room to vent out to process some of the information. There's a lot of guilt on the one hand—the guilt they feel as parents, all the time guilty as a parent as well, but also some guilt they feel towards the eating disorder which serves like as an external entity, which is also another family member—conflict between different loyalties. What we found is that towards session eight, parents describe the mealtime conflict from magically decreasing improving everyone's quality of life, and strengthening the relationships. We often invite, make the other parents without the eating disorder become more involved in the feeding interactions and in all these fears—these are couples. It's many times I've been able to you know communicate very effectively and have a very close thing bond between one another in all areas but the food and eating arena. Here you know many times from parents that the other parent without the eating disorder really loves their partner and understood that this partner becomes highly anxious when food is mentioned, so they thought the other parent that the best thing to do the most supportive thing to do would be to just withdraw and let the other person you know, deal with feeding in. We can hear sometimes someone says, you know, “I've been in the other room and I heard dad and my son's screaming at one another over what to eat and children asked for seconds, and he wouldn't let them,” and she would say, “I just knew that he's too anxious about it and too controlling, and I didn't want to interfere,” whereas, you know, some of their inventions are given to parents with eating disorder, and I thought you have yoga or the wife with friends and the other person is in charge of dinner, this reduces a lot of the anxiety, you know, contrary to what people believe. And also many partners, because they want to be good partners because they want to help and don't know how to help, they collaborate with eating disorder in a very unhealthy way. Again, they do this in order to reduce conflict. So you know, we had, for instance, a partner who used to buy a lot of cabbage to his wife because that's what she was eating, maybe she was learning mom, you know, those unhealthy cabbage diets, and used to talk about it more with the cashier at Trader Joe's, than with his wife, and she would ask, “Do you guys have a rabbage or something like how all of these cabbages,” and he would actually speak with her more than he would have, you know, talk with his wife. And we facilitated greater interaction with them on this topic, you know, in other areas, they were a great couple, and they were very open with one another and very communicative and relied on one another, this specific domain felt like something both of them did not feel like they were able to touch, so this is another thing that we're facilitating, you know, another partner that boss laxatives every week to his wife without asking, “Why do you need, you know, dozens of laxatives every week,?” etc. So again, know, when we talk about mostly moms, you know, parents with eating disorder history, internal state and their relationship with a child, we always need to remember the, you know, extended circles, the other family members and the cultural environment in which all these behaviors are being carried out.

Yeah, absolutely. Thank you so much for all of that. I just wanted to mention right at the beginning of that, you mentioned the Division of Responsibility Ellen Satter's model, and so if anyone's listening and isn't sure what that is, we actually interviewed Ellen Satter a few months ago. So, you can go and search Division of Responsibility on YourParentingMojo.com. And you'll find that interview and then you can get a deeper dive into what that involves. And yeah, that was one of the reasons I was so excited about reading your book, was to see the interplay between these topics. One thing that I often run off and maybe sometimes see from parents, and you sort of alluded to it, when you mentioned mothers a minute ago, and then corrected to parents, oftentimes, it is sort of female-identifying parents who are navigating this, but I see another group of parents who report a different kind of challenge, often the female-identifying parent that comes to me and says, “I'm doing okay, my partner is super controlling, my male-identifying partner is super controlling over our child's eating, and their parent was really controlling. I'm wondering if there was an eating disorder history and their parent as well.” And the female-identifying parent, you know, the mother is not sure what to do, because the dad won't accept any help or accept any suggestion that something might be wrong, even never mind that we do anything differently. What advice would you give to parents who are in that situation?

Decisions about our parenting about our family, and you know, any changes we want to implement in our family if we live with partners that we trust, love, and appreciate, then changes that are be carried out together—collaboration. I would advise any parent who's concerned about partner or about, you know, the kind of messages that they communicate to their kids intentionally and unintentionally, to seek advice you know, you can speak with any clinician who has expertise with parents and in parenting and gauge their advice. And I think the most important thing is just to a conversation just by you know, meeting in the middle of finding the common ground is more important than the ultimate decision that you guys reach at the end. I think we want to facilitate greater communication, more openness, more trust of one another, you know, I had them many times where moms called and said, “I want to come but my husband doesn't or the other way around, what do you suggest?” And I said, “Well, you know, you're married to her, not to me, I mean, if you guys have been together for five years, you know your ways and you know making her do things that she, you know, decides, like visiting extended family, or all every couple has their own types of negotiation. So it's important to you and it should be important to you, then you find ways to let your partner know that it's important for you.”

And then as we wrap up, I'm curious about the efficacy of this program and about how it can work for different people in different circumstances. I think one of the criticisms I see not of this program specifically but in eating disorder treatments, in general, is that they tend to be very formulaic, and they're going to push you through at the pace that they want you to push through, and you need to show progress, particularly in the US to insurance companies who want you to be fixed at the end of the program. I'm wondering if the answer here is not to consider this, you know, you mentioned a 12-week program as the program and that's it, but it's sort of part of a broader suite of services that this parent this family is going to need. And then what kind of efficacy rates do you see in the people that you treat? How does that play out?

So, these are great questions. We have data to show high efficacy in these families, with both parents with eating disorders and their partners both reporting lower eating problems and other problems in their kids. And or satisfaction as a parent lower eating depressive and anxiety symptoms and so on. We also seen the good results also in adaptation that we've made for parent-based prevention, for instance, with parents following your bariatric surgery, so people might have a greater genetic predisposition, higher weight status. And they undergo weight loss surgery, bariatric surgery, they have more, you know, concrete reasons to be worried about their kids at times, oftentimes, they need to dramatically change the way that they eat, and they don't know how to, you know, map this change on to the entire family's routine, so we created an adapted version for parent-based prevention for families following bariatric surgery, and we shortened it for six weeks, and we've delivered it fully via telehealth. And we published the results recently, also demonstrating great efficacy, particularly the acceptance of parents of peers and their readiness to continue the conversation with one another or with other people who support them in their parenting beyond time-limited programs. So, we're very, very happy about the results that we're seeing.

Yeah, and seeing this is a journey, right? This is not a 12 weeks and your fixed kind of thing, this is a lifelong thing that's going to be part of your life, and navigating is going to be part of your life, and needing support for that is going to be part of your life for a long time too.

That’s true. Also, you know, as your child gets older, and you know, they enter different phases in their lives and raising a toddler or kindergartener, or elementary school kid where you know, you do have more control than them when their routine schedule eating choices, etc., versus a teen or a child going to college, they have different developmental needs during the different stages in life, and your ability to control what they're doing is limited, also some rebellion on the child side, and we prepare parents to you know, anticipate these changes and identifying the resources for support in their environment that they could reach out to if they need for support.

I'm wondering if there's any way that parents can find practitioners who are trained in your program who have specific expertise? Is there a resource that you can point parents towards?

That's a great question, you know, the more I provide trainings and education, and as you know, our field, changes in discussions of external forces on parenting become more common. I think more and more clinicians are able to address these issues and discuss them in treatment. I think, you know, in the main eating disorder programs across the US, there are many clinicians who have I had the privilege of training, though, I think, you know, just asking the clinician if they feel competent and ready to address this issue as well would be where I would start.

So, asking the clinician whether how they see broader societal forces impacting this. What they see is the partners’ role in supporting me. Those kinds of questions could help get us to whether this is somebody who is comfortable seeing this as a broader problem, and not just something in me that needs to be fixed.

Yeah, absolutely.

Okay. Super. Ultimately, what we need on your website is a list.

Okay, yeah. Yeah, as we're speaking, I understand this needs to be the next step.

Yeah, well, thank you so much for being here today. And for writing the book, which I found really, really useful and insightful. Again, it's not very long, and it is geared towards practitioners, but I got a lot out of reading it, so I would encourage anyone who's interested in this to take a look at that book. It's called Parents with Eating Disorders and Intervention Guide. And so, I'm really grateful for your time here today.

Thank you so much. Thank you. Thank you for inviting me.

Yeah, and all of the references for today's episode can be found at YourParentingMojo.com/eating disorders.

Hi, this is Jenny from Los Angeles. We know that you have a lot of choices about where you get information about parenting, and we're honored that you've chosen us as we move toward a world in which everyone's lives and contributions are valued. If you'd like to help keep the show ad-free, please consider making a donation on the episode page that Jen just mentioned. Thanks again for listening to this episode of The Your Parenting Mojo podcast. Don't forget to head to YourParentingMojo.com/recordtheintro to record your own messages for the show.