Speaking of Psychology - The ‘silent epidemic’ of eating disorders, with Cheri Levinson, PhD

Episode Date: May 3, 2023

Researchers who study eating disorders sometimes call them the silent epidemic. Despite the stereotype that these disorders afflict only young white women, the truth is that they occur among people of all ages, genders, ethnicities, races, shapes and sizes. Cheri Levinson, PhD, of the University of Louisville, discusses myths about eating disorders, how our toxic diet culture combined with genetic vulnerability can spur eating disorders, what treatments are available, and how researchers are using new technologies to come up with more effective personalized treatments and expand access to care. For transcripts, links and more information, please visit the Speaking of Psychology Homepage. Learn more about your ad choices. Visit megaphone.fm/adchoices

Researchers who study eating disorders sometimes call them the silent epidemic. Estimates vary, but as many as 30 million Americans may suffer from an eating disorder at some point in their lifetime. And despite the stereotype that eating disorders afflict only young white women, the truth is that they can occur among people of all ages, genders, ethnicities, and races. Psychologists are working to learn more about the causes of eating disorders and how to treat them. Researchers are using new tools and technologies to come up with more effective, personalized treatments and expand access to care. So how common are eating disorders among adults, teens, and children?

What do researchers know about the causes of eating disorders, both genetic and environmental? What role does our diet-obsessed culture play in spurring eating disorders? What treatments are available now and how effective are they? barriers to treatment to patients face and how my technology help make treatments more available and effective. Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. My guest today is Dr. Sherry Levinson, an associate professor in the Department of Psychological and Brain Sciences at the University of Louisville, where she directs the Eating Anxiety Treatment Lab.

Her research focuses on building new interventions for eating disorders, particularly using analytical methods and new technologies such as wearable sensors as part of personalized treatments. Dr. Levinson is also the founder and clinical director of the Louisville Center for Eating Disorders, where she treats adults, adolescents, and children with eating disorders. She is also vice chair of the Kentucky Eating Disorder Council, a state-sponsored council charged with improving eating disorder treatment in Kentucky. Thank you for joining me today, Dr. Levinson. Thanks for having me. I'm really excited to be here and get to talk about this really important topic. Yeah, me too. So I mentioned in the introduction that you and other researchers have called eating disorders a silent epidemic.

Has this always been true or is the prevalence of eating disorders on the increase? I would say it has always been true and the epidemic is getting larger and more problematic. hospitalizations and children and adolescents have doubled in the past year, and the prevalence rate for eating disorders is unfortunately rapidly growing. Now, I would guess that most of our listeners have heard of disorders like anorexia or nervosa or bulimia, binge eating disorders, things like that. Are there other diagnoses, other eating disorders that people might be less familiar with? Yeah, definitely. So as you mentioned, anorexia nervosa and bulimia nervosa are the eating disorders we usually hear about. But there are many additional eating disorders. So, for example, binge eating disorder is a newer, recognized eating disorder. It's similar to bulimia nervosa, except in that there is, you're eating a large amount of food and feeling out of control when you're eating it. But there's no compensating.

impensatory behaviors like purging or excessive exercise afterwards. And then actually, the most common eating disorder is what's called other specified feeding and eating disorder. And this is just a catch-all category for any other type of problematic eating that is causing impairment and distress in the person's life. And other specified feeding or eating disorder are osfed for short. That's a mouthful, right? is actually 50% of all people with an eating disorder would have OSFED.

And this includes things like a typical anorexia nervosa, which is just the same as anorexia nervosa, except it occurs at all weights. You don't have to be underweight. And this is a very, very common and impairing eating disorder. And I also mentioned in my introduction the misconception that eating disorders mostly affect young white women. What are some of the other myths around eating disorders? Yeah, so I think that's a big one. There's a lot of stereotypes that it's young white women, but in fact, we know that eating disorders impact men, they impact children, they impact older adults, they impact minority

individuals. There's lots of other myths around eating disorders as well. I think one is that people cause eating disorders or that it's just a phase. But we actually know that eating disorders are a highly genetically heritable illness, the same way that cancer or diabetes is heritable. And then the trigger for many eating disorders are societal factors, but they are biological illnesses and they are in a phase. People don't grow out of them. You really need expert treatment.

and lots of support to get better from an eating disorder. So you mentioned the genetic component. If someone has that predisposition to having an eating disorder, what's the kind of trigger that might put them into a full-blown phase? So two of the biggest triggers for an eating disorder are any type of restriction and critical comments about weight, shape, or body. So I can talk a little bit more about both of those. For restriction, this would be any sort of energy, food energy deficit.

So this might look like going on a diet. It might look like, oh, I'm having my tonsils out, and so I can't eat for 48 hours, and that might set off the eating disorder. But I think what's really important to think about with this is that we live in a culture that really promotes restriction and dieting behaviors. And so anybody that has this genetic vulnerability is pretty much guaranteed to at some point in their life go on a diet or go on a fast. And that can really be what triggers the eating disorder. The second really big risk factor are these critical comments on weight, shape, and body.

And again, our society, unfortunately, is really ripe with these sorts of comments and judgments, especially for folks who live. in larger bodies, which we know, for example. And another one of those myths is that eating disorders only impact people who are thin. But actually, most eating disorders are in people who are in mid-size or larger bodies. And any sort of critical comment, whether that's from a pediatrician or a primary care doctor or a parent, that can be something that causes people to change how they're eating. Again, spurring that restriction, and that will trigger an eating disorder. Is there a particular age or time in life when eating disorders most commonly start?

Yeah. So we used to think that the age of onset for most eating disorders was between 13 to 15, so in adolescence. But actually, what we're seeing now is a younger and younger kids. So we're seeing between 9 to 11 years old. is when many eating disorders are beginning. Of course, an eating disorder can occur at any time point during the lifespan, but we do see most of them that really start between the ages of 9 and 13. And unfortunately, like I said, we are seeing more younger and younger kids who are getting eating disorders.

And if I'm a parent, what should I look for to know that my child may be developing and eating? disorder and it's not just a phase, as you said. There's a lot of things that parents can look for. So the number one most important thing is any sort of changes in eating habits. This is why we know that family meals can be so protective against eating disorders because parents are there to observe and notice if kids are starting to eat differently. So if all of a sudden your kid isn't finishing their food or all they want to start cutting out a food group. Maybe they decide to be vegetarian or vegan, but it's not really

clear what the reasoning is for why they want to cut those foods out. You might notice that they're starting to take food to their bedrooms, or maybe they are starting to push their food more around the plate and not finish it. Other things to look for are isolation. So if your kids starting to not do activities that they used to do. Maybe they're going to their room instead of hanging out with the family. You might also notice kids starting to wear baggy or clothes to try to hide their body, or they might start to feel really uncomfortable, maybe going to the pool in a bathing suit. All of these things are signs that there might be an eating disorder developing. And what I would really urge parents to do is to keep an eye on what your kid is eating. So I know that when kids start to go

into adolescence, oftentimes they start to gain a lot more independence with what they're eating and food preparation and all of that sort of thing. But as a parent, it's really important to keep an eye and make sure that your kid is eating enough because the adolescence is also a time when kids are growing, when their brains are developing. And for, brain development and for growth, they have to be getting enough energy from food to properly develop. Now, what about on the other end of the lifespan? Is it common for somebody older, like in their 40s or even in their 60s, to suddenly develop an eating disorder? Yeah, we definitely see that happening a lot as well. Again, I think that this is a age group where really eating disorders

have been under-detected for a long time. So there's two groups of people in older adulthood or mid-adulthood that we see. And that's people who have really had an eating disorder since they were 12 or 13 years old. And they have been really good at hiding it. They've kind of worked it into their life. But it's still just causing so much impairment and distress and shaping the way that they're living their life. And we'll see lots of people coming in that have had,

20, 30 year-long eating disorders that haven't been treated. The other group is we do see new onset eating disorders, and this can be brought on by a wide range of things. So we see a lot of it happening around retirement, around menopause, around giving birth to kids. All of these things can be triggers for eating disorders with changing in hormones and different sorts of expectations and roles. So we do see this kind of thing come up in all different age groups. And what are some of the treatments that are available right now and how well do these options

work for people? Yeah. So there are treatments out there. And what I want to say is that if you think you might have a eating disorder or somebody you love has an eating disorder, recovery is possible. are good treatments out there. Catching the eating disorder as early as possible is the most important thing to do because the earlier you catch the eating disorder, the higher likelihood of full recovery.

So we have a couple different types of treatments. When we're talking about outpatient treatment for adults, our best treatment is cognitive behavior therapy enhanced. If you have an adolescent, the best treatment is what's called family-based treatment. For many people, though, outpatient is not enough, and people will need to go to a higher level of care for eating disorder treatment. So this might be an intensive outpatient program, a partial hospital program, or even residential treatment or inpatient, depending on the severity of the eating disorder. And in those types of centers, they're receiving a multidisciplinary-based team type of treatment that's called eating disorder specialty care. and that is really the standard of care for at higher levels of care and involves working with a psychologist or therapist, a dietitian, and usually either a physician and or a medical, psychiatric medical provider.

So in terms of response rates, when we're looking at outpatient treatments, we know that about 50% of people who receive either family-based treatment for adolescents or cognitive behavior, behavior therapy enhanced for adults will get better. So obviously, 50% is not ideal, right? We want to get that number up there. The numbers are similar for people receiving specialty care. We see about 40 to 50% of people who get better. But I think one thing that's important to hedge here is that that's from one round of treatment. So it might be, for example, that somebody needs to go into specialty care three or four times, and then they hit that recovery mark. And that's going to push up recovery bits a little bit. So I think the takeaway from this is it might take multiple rounds of treatment.

It might take trying different types of treatment to figure out what type of treatment works best. And we need to do better in terms of creating new treatments for eating disorders that have a higher than 50% success rate. Now, what about something like bariatric surgery? I mean, that's a treatment for some people, right, who are just maybe binge eaters. I mean, they just can't get control. Is that effective? And is that sort of like the last line of defense?

So bariatric surgery is not a treatment for an eating disorder. And I would never recommend anybody with an eating disorder gets bariatric surgery. um bariatric bariatric surgery can be helpful in terms of health issues um but most of the effects are short term and when you look at longer term data

bariatric surgery doesn't actually have um as high of efficacy as we would like it to bariatric surgery is also one of those triggers for eating disorders. Oh. Um, it can either trigger an eating disorder or it can

um, reset off an eating disorder that maybe was in recovery. So we actually know, for example, that for binge eating disorder, one of the things that helps the most is regular eating and eating a variety of foods. So when I say regular eating, what I mean is eating three meals a day and two to three snacks about every two to three hours because most binge eating is triggered from restriction. So what happens is somebody goes all day and they're not eating very much. the end of the day comes along and they're starving and then maybe something stressful happens

and that is what sets off a binge, right? So if we start regular eating and we normalize the eating patterns, that actually starts to decrease and prevent a lot of the binge eating. That coupled with learning how to deal with stress and emotional reactions is really what goes into CBT treatment for binge eating disorder. So if you think about it, bariatric surgery, surgery is actually very much changing the way in which you eat, and it's limiting what you can eat. And so that can actually trigger more of these binges. Is there any kind of drug therapy that works either for anorexia nervosa or for binge eating? And I'm also thinking about the news coverage lately of drugs like OZempic, right, that are being

prescribed as a treatment for obesity. Yeah. So there is minimal medications that work for eating disorders. So again, we know that our behavioral treatments are better than medication treatments. Medications can be very helpful for treating the co-occurring issues like anxiety and depression worry, but they don't actually treat the eating disorder. In terms of Ozembeck, this is another one where maybe on the surface, kind of like bariatric surgery, It seems like, oh, hey, maybe this could be helpful for an eating disorder.

But Ozymbic is essentially what it's doing is it's dampening your hunger and fullness cues, and it's making you feel full when you're not really full. And that, again, is the same sort of thing that can set people up to binge more. It also has some pretty scary side effects, very, very scary side effects, both in terms of being on it and when you go off of it. I've been doing a lot of reading on it lately, and my professional opinion is to stay as far away from Ozymbic as possible. Unless, you know, you have one of these medical conditions that it was originally...

Or you're diabetic. Develop for it, right, if you're diabetic. But if you're losing it for weight loss purposes, it is going to end up doing more harm than good to your body. And it's probably actually going to end up leading to weight gain. the long term because we know that most of the time when people lose weight on diets or from medications or what other other sort of form they're using, that weight loss never sustains itself past a year and what ends up happening is your body says, I don't like this. I'm not supposed to be at this

body size and your metabolism kicks in and it messes with your metabolic features and your body ends up wanting to then be at a higher weight than it was when you even started the diet. And that's where we actually know that about 98% of diets, unsupervised diets, fail and actually lead to weight gain. Now, much of your research is centered on using technology to develop effective personalized treatments. Can you talk about that? What kind of technology are you using and how do they work?

Yeah, so we have a couple clinical trials that we are running right now with some really exciting new treatments. So I'll just briefly talk about a couple of them. So one of the clinical trials that we're running, we use smartphones and we use a type of people get assessments on their phones multiple times a day about their eating disorder symptoms and things like. anxiety and depression. And we use that to create an algorithm that tells us these are the symptoms that are causing the eating disorder that are really important for maintaining the eating disorder. And then we match that to evidence-based treatments to help with that specific problem. And so in that way, we're personalizing treatment using the smartphone assessment and fancy algorithms that I won't go into. But right now we're running a trial where we're testing personalized treatment versus cognitive

behavior therapy enhanced that type of treatment that right now is considered the standard of care. We're also using wearable sensors to develop algorithms that can predict onset of eating disorder behaviors. And our hope is to eventually be able to use that to Like have something in your Apple Watch, for example, or your Garmin, that can alert, hey, you might be getting ready to have a binge eating episode. Let's work on these skills. And then finally, we're developing things like virtual reality and digitally based avatar treatments to treat things like fear of weight gain, which is a major symptom in all eating disorders.

So we're using a lot of different technologies. And really our hope is that we can take this technology and use it to improve treatments that exist, but also to be able to personalize treatment because we know that everybody's eating disorder doesn't look the same. And we want people to really be able to get the care that is going to be most helpful for them. Well, speaking of technology, let's talk about the impact of social media on eating disorders. I mean, I think we all know that there are websites, particularly that young people will go to about binging, purging, other things that they can be doing that would not be healthy. And I'm wondering, is that contributing to the growing numbers of people with eating disorders today? Let's talk about

that a little bit if you could. Yeah, sure. I definitely think that social media can be a contributor to disordered eating and eating disorders. There's a little bit of data, I think actually out of Australia that's beginning to look at some of the causal relationships between social media and disordered eating, body dissatisfaction in particular. I think what we need to keep in mind with social media is that it can be a positive or it can be a negative, right? And we know that actually providing education to kids and adolescents on how to tailor their social media to make it a more supportive and body neutral platform can completely change

the way that they're interacting, right? So if you have somebody who's going on social media and they're seeing all of these weight loss ads and they're seeing very thin people and they're seeing all these people putting pressure on appearance, that can lead to comparisons, can lead to disordered eating. But you can also use social media in a way to promote body neutrality and the function of the body. Why our bodies are amazing, right? And so I think that if we can get more education and more personalization of how to best. use social media, we could end up helping instead of harming from social media. That would be great. Yes, definitely.

What about the role of sports? I know we've all seen these female gymnasts who weigh about 100 pounds, or maybe you go to the gym and there's some guy who's there every day for hours on end trying to get super ripped. I mean, how can coaches and others in the world of sports walk that line between helping athletes become their best without damaging their bodies with diets, supplements, and other unhealthy regimens? Yes. Yes, this is a great question. And so important. And again, I think if we want to think back to what we talked about at the beginning about how the environment, when it

comes to any sort of dieting, any sort of critical comments, that can spur eating disorders, a lot of athletics have a lot of focus on weight, on shape. There might be. comments about weight in shape. There might be even dieting that is worked into different sort of sports programs. Like if you think about wrestlers having to meet a certain weight cutoff, that is really inherent in their sport. So what I always tell coaches and people in athletics is that instead of focusing on calories, on weight loss, on how your body looks, what you really want to focus on is the function of your body. So your body is strong. You can and run really fast and really far.

You can hit the ball hard. And you need food to fuel that, right? Where do we get our energy from? I ask my patients this all the time, and they roll their eyes at me. But where do we get our energy from? We get it from the food that we eat, right? So if you want to be a high-performing athlete, you have to have energy to fuel your body. And you have to have enough energy to feel your body.

You are not going to perform well if you're not properly fueled. So that's what I think coaches can talk more about is properly fueling our body, which means eating regularly, eating a wide variety of foods, and all of the amazing functions that our body does for us. And in that way, we can create a safer environment where eating disorders are not going to thrive. What is the relationship between anxiety and eating disorders? Why are they so often intertwined? Yep.

So a lot of our research is focused on the overlap between anxiety and eating disorders. And we know that eating disorders co-occur with anxiety disorders up to 95% of the time. So this is really important to know that if somebody goes into treatment for an eating disorder or if they are living with an eating disorder, they don't just have an eating disorder. They're also going to have an anxiety disorder, depression, you know, other things co-occur like, substance use and personality disorders. But eating disorders are really fear-based disorders, right? In the same way that anxiety disorders are fear-based disorders. Eating disorders are centered around different types of fears than maybe like you might

think of in panic disorder, for example, or social anxiety disorder. And eating disorders, the fear and anxiety is really focused on fears of weight gain. So what's going to happen if I gain all this weight. are people going to judge me? Am I going to get abandoned? Fears of food, so wanting to avoid certain foods. Fears of social judgment, people are going to judge my body critically. And then also fears of how your body feels. So it can be things like misinterpretation of bodily sensations.

So I feel full, and that makes me feel afraid because I think I'm gaining all of this weight. So really at their core, eating disorders are anxiety-based, and that's why we see so much anxiety with eating disorders and why our team, my lab, is working on developing treatments that are adapted from anxiety disorders to the eating disorders to treat eating disorders more in line with anxiety-based disorders. One thing I always like to say here is that so obsessive compulsive disorder, which is highly overlapping with eating disorders, was thought of as a refractory illness, something that couldn't be treated until the development of exposure and response prevention treatment, which is how OCD and anxiety disorders are treated. It's an anxiety-based

treatment. And similarly, we've had so much trouble treating eating disorders, but when we start to apply these anxiety-based treatments, we really see huge decreases in symptoms and anxiety. It's a very, very promising area of research and new treatment. Let's talk for a minute about who is more likely to get an eating disorder. I mean, there is the stereotype that it's women and girls. Are eating disorders more common among women and girls than among boys and men? Yeah, so they are more common among women and girls, depending on the type of disorder we're talking about. if we're talking about binge eating disorder, it's actually 50% men, 50% women who will develop

binge eating disorder. And I think another thing that we need to think about is that rates and men are probably a lot higher than we think because all of our assessments and tools that we use to detect eating disorders have been developed for women. And eating disorders in men may look a little bit different. I mean, they do look a little bit different than in women. And so a lot of the estimate of low prevalence in men is really possibly because we just don't have good ways to detect it and we aren't looking for the right things. So, for example, with a male eating disorder, there might be much more concern about having bigger muscles and working.

lifting weights more, whereas you might see less of that with women, but we're not asking about those things, so we're missing it a lot of the time. So, I mean, I think the overall takeaway message is, yes, being a female does bring with it a higher likelihood of having an eating disorder, but men also get eating disorders and at much higher rates than we used to think. Now, you've talked about the role that a toxic diet culture plays in promoting, promoting eating disorders in the United States. And at the same time, a lot of people, including physicians and public health officials, are talking about the need to fight the obesity epidemic. How do we balance these two competing agendas in a way that doesn't spur

disordered eating? Yes, this is so, so important. Something I think about, talk about, and write about a lot. I think that what we need to think about is that people who are wanting to treat the obesity epidemic, what they're really concerned about are the underlying health problems that are sometimes correlated with being in a larger body, right? But the key takeaway here is that correlation does not equal causation, right? And unfortunately, for too long, our health system has the incorrect belief that being in a larger body automatically means that you're unhealthy, and that is just not the case. You can be in a larger body and be as healthy or more healthy than people who are in a small body.

What's really important are the health behaviors, right? So when I say health behaviors, what I mean are things like eating regularly, eating a large variety of foods, eating whole grains, joyful movement. And then there's the systemic issues that we're not even talking about, things like food insecurity that prevent being able to regular eat, right? Things like having access to green space where people can actually move their bodies. These are the actual things that I think need to be worked on to help improve health, not individual factors or individual treatment of obesity, in quotes.

So one thing that I like to point out is that the whole obesity, epidemic that really doesn't exist, but that Americans have been fed that this thing exists, was really brought out of wanting to make sure that our kids were safe and that they weren't developing these terrible health problems down the road, right? So one statistic that I always like to say is, well, you know, and so to back up a little bit, what we think about here is, well, what are the health problems that we're thinking about kids that we want to prevent. And a lot of it are things like diabetes, right? So the statistic that I like to give is that if we have 100,000 children in adolescence, 120 will have Down syndrome,

56 will die from sudden infant death syndrome, 15 will be diagnosed from cancer, 12 will develop type 2 diabetes, and 2,900 will have an eating disorder. So, we'll be diagnosed. We'll have a eating disorder. So we're talking about 12 kids who are going to develop type 2 diabetes versus 2,900 that are going to have an eating disorder. And all of these sorts of things that people are doing to try to prevent, again, in quotes, the obesity epidemic, are things that cause eating disorders, asking people to restrict their food, making critical comments on their body and their weight and their shape. those things cause eating disorders. So unfortunately what we're seeing is that people well-intentioned, they're well-intentioned and they're trying to treat obesity, which really is not a problem in itself, and they're causing eating disorders. And that's part of why we're seeing these huge growth in eating disorders. So the estimate is in the next year there's going to be 2.9 million new cases of eating disorders in kids and adolescents.

just in the next year. So I think that what we as a society need to start to grapple with is, number one, the size of your body does not equate to how healthy you are. And number two, we really need to think about our priorities. Are we so focused on obesity because of these inaccurate messages about what it means to be larger because of things like weight stigma? Is it really a problem? Maybe not. And maybe we need to be thinking more about the harm that we're causing with eating disorders instead of falsely trying to change people's body size, which we know doesn't work, right? Like, as I mentioned, 98% of diets fail. Your body size is actually 80% genetically based. That's about the same as eye color. You would never try and say, oh, I don't like your blue eyes. Let's try and change those to brown, right? So it's like, oh, oh, I don't like that you're in a large body that, you know, is genetically based. Let's try and make you smaller, right? And then we don't actually have a good way to make people smaller either.

Now, you've done advocacy work in your state to increase access to eating disorder treatment. What are the biggest barriers to patients when they're trying to access treatment? Is the problem, insurance, availability, or is it something else? Yeah. So we just did a large wide-scale study with Project Heal, which is a not-for-profit organization that tries to provide access to eating disorder treatment for people who are having difficulty with accessing treatment. And we surveyed 3,000 folks with an eating disorder who were treatment seeking, but maybe necessarily weren't able to get treatment. because we wanted to find out what are the barriers. I mean, I hear about the barriers all the time,

but we wanted to actually quantify what the barriers were. And we had five different barriers that categories that we were looking at. But overwhelmingly, the biggest barrier was financial. And by that, I mean insurance coverage. So insurance coverage for eating disorder treatment is very, very limited. especially if you have Medicaid or state-based non-commercial insurance, there are very few eating disorder treatment centers that take that because the reimbursement rates are so low.

So really, to be able to access treatment, you have to have commercial insurance or a lot of money, which unfortunately means only a small percentage of people, 20% of people with an eating disorder end up being able to access treatment. So definitely the biggest barrier is financial, is the way that our insurance system is set up. There's other barriers, though, too, like there aren't a large availability of providers, especially in rural areas and for minority populations. But again, that can be tied back to the fact that it's very hard to do that work if you're not going to be able to get coverage from an

insurance company to do it. Other things are just lower quality of care in certain areas, geographic barriers. So, for example, the clinic that I run is the only eating disorder center and the entire state of Kentucky. Most of our eating disorder treatment facilities are either on the west or the east coast or in Colorado. So many people have to travel four to, you know, 24 hours to get treatment. And many people don't have the resources to do that type of treatment, especially for three to six months, which is often how long folks are in a higher level of here. So it sounds like technology is really the answer for a lot of people, because that will be more readily available. Technology, I think, in continued advocacy for systemic change so that we can

have better coverage. If you look at, for example, the mental health parity laws, and each of the states have a rating for how well they do mental health disparity from A to F. So, you know, everybody wants an A. Nobody wants an F. Well, I think it's something like 47 states get an F and like two states have a D minus and one has a D. So, so I, so I, so I, I mean, the point is, is that we're not doing well when it comes to mental health parity. And that's not just eating disorders, that everything. Yeah. Right.

So I think that while technology is definitely an answer that I think is going to provide so much more access to more people, there also needs to be this advocacy and push to our legislators to take mental health seriously and to really change the systems so that everybody can access. high quality care. So last question, something practical, since we're talking about barriers, what should you do if you or someone you know has an eating disorder or you suspect that they might? What's the best way to get help? Yeah.

So what I would say is don't hesitate to get help. As I mentioned earlier, the sooner you intervene on an eating disorder, the more likely full recovery is possible. There's a lot of good resources out there that can get folks to good treatment. So I mentioned Project Heal. That's a great resource. The National Eating Disorder Association, or Nita, is another great one that has links to different treatment.

They actually have a chat bot that one of my colleagues has developed that helps get you into treatment. So you don't even have to talk to a person. And you can always go to our website, which is, the Louisville EatLab.com and the Louisville Center for Eating Disorders. We have resources on there for how to get treatment. Nita is great for how do you, they have resources on how do you talk to somebody with an eating disorder. You can also reach out to your local psychology organization.

So for example, in Kentucky, we have the Kentucky Psychological Association. All states have a similar sort of association that you can reach out to. And all of these resources are out there to help get people into the care they need. And what I'll stress again is just that you really do need people with specialty training to treat the eating disorders. You want to be looking for evidence-based care so that people don't end up bouncing from one place to the next, not getting the type of treatment that's going to be helpful. and just how important it is to reach out for help and not to be ashamed of having an eating disorder. Like I said, you would never be ashamed of having cancer or some other type of illness, right?

In the same way, we really want to break this stigma around having an eating disorder. They're common, they're prevalent. We can treat them, and they're nothing to be ashamed of and really want people to get help for them. Thank you. That's really great. helpful advice. I appreciate it. And I want to thank you for joining me today. Dr. Levinson, it's been very interesting. Thank you so much for having me. It was lovely being here today, and I'm excited to get some of this out there for folks to hear about. We will definitely do that.

You can find previous episodes of Speaking on Psychology on our website at www. speakingof psychology.org or on Apple, Stitcher, YouTube, or wherever you get your podcasts. If you have comments or ideas for future podcasts, you can email us, at Speaking of Psychology at APA.org. Speaking of Psychology is produced by Lee Winerman. Our sound editor is Chris Kondyenne. Thank you for listening. For the American Psychological Association, I'm Kim Mills.