Dr. Rachele McCarthey- Eating Disorders
(will send resource list)
How to talk about weight? How should we talk to each other?
Get away from the “good and bad” – talk about healthy- talk about it in a positive way
The child might not actually lose weight- “How do we help your body get the nutrition you need?”
Eating Disorders and DefinitionsAnorexia Nervosa- not eating enough, not meeting nutritional goals and needs, doesn’t mean they are profoundly under
weight
RFID: Avoidant/Restricted Food Intake Disorder (F50.82) probably most common for our clients
Bulimia: binging and purging
Binge Eating: most common eating disorder, most adults report it started as a kid
RFID: If concerns are clinically significant, it should be a part of treatment.
Conversation should start in therapy, setting it with goals, if you are hearing from “everyone” that this is an issue,
prioritize considering other clinical issues
Milieu benefits- peer support, using staff to support goals (staff eating with patients to model appropriate eating)
Have a plan up front to address behavioral concerns.
Social validation and “peer pressure” can actually encourage more adventurous eating.
“We want kids to eat.” Not skipping meals, not using food supplements, etc.
How do we engage the family?
Talk about what you see, objective observations about how they are responding to foods they are bringing
Consider food as a “medicine” –removing food, providing alternatives, etc. shouldn’t fall to child to manage temptations,
help them have the foods they need at home.
Can the family access those foods?
Harmons- cooking classes, nutritionist- engaging family in healthy food activity
If this isn’t working- dietician might be helpful- might end up focusing on weight instead of healthy eating
Myplate.gov has calculator that can determine base recommendation for daily calorie intake
Therapy can focus on paying attention to those body cues- “hangry”
How do you bring “joy” back into eating? Look at the internal cues
Body image: What does your body do well? What do you like about your body? Not just appearance but was is the
strengths of your body.
You may never like your body- but you can ignore it- “it is what it is” (Radical Acceptance) just being in your body, not
necessarily loving it but just being okay with it.
Movement- recognizing how exercise makes it so they can do more, ability increases
Psych Techs addressing when peers are modeling each other. Bring it up to the group (therapist??).
We are breaking the rules because we aren’t supporting each other with doing what our bodies need.
Point out behaviors you do want to see, shift the dynamic and mix up the group so same kids aren’t always eating
together.
Line Staff: Kid won’t eat- “I’m wondering why you aren’t eating today, is something going on?”
“I’m worried about you not having enough energy.”
“Is there something you feel more comfortable eating?”
Look at ways to shift to new opportunities and options, recognize when they try.
Teenagers- refusing to bring lunch- have something small but not necessarily sustainable- graham crackers, etc. So they
have something but still realize it’s not something they want to eat every day. Can translate this to home.
Under weight- “we need to come up with a plan” either they pack what they need or parents will need to take control of
it- teenagers losing that ability to make the decision.
“We put too much credence on BMI”
Questions to exploreTell me about your eating and appetite? Have both parent and child give feedback.
What are concerns? What do meals look like?
What does the day look like?
Body image; directly “How do you feel about your body?”
“Tell me what you like about your body?”
May be underlying issues that have nothing to do food and eating issues.