Dr. Jen Gaudiani joins the Family Brain to talk about creating a positive home and family culture around food and body love.

Dr. Gaudiani is the founder of the Gaudiani Clinic and author of Sick Enough, A Guide to the Medical Complications of Eating Disorders, We talk about the cultural messages kids are sent from all directions and how to create a safe landing place in your home that can help counter these cultural messages. We explore concrete ways to nurture a healthy body image in teens.  Dr. Gaudiani talks about her practice which helps manage medical complications related to eating disorders via teletherapy to patients across the US.

Body Positive teen therapy

“Dieting doesn’t work and is almost universally harmful.”

– Dr. Jennifer Gaudiani

In this episode:

At the time of the recording, WW, formerly known as Weight Watchers, had just launched an app called Kurbo to help kids aged 8-18 lose weight.  We talk about the damage that can cause kids and how dieting at any age does not work in the long term and actually increases negative health outcomes.  We talk about the science behind this and how our bodies are created to notice fewer calories and slow metabolism to ensure survival.  Dr. Gaudiani talks about how dieting is almost universally harmful.

She talks about our culture of thin privilege and how it can contribute to good parents compromising their kids' health by restricting food and shaming kids about their bodies.  Like dieting, shaming people does not work and tends to cause the opposite effect of increasing desire for forbidden foods.  We talk about instances with our own kids and how we have managed to navigate this culture of the thin ideal within our own lives.

The main point we discuss about helping your teen create a positive body image is by creating a home environment that does not have body stigma.  That looks like talking kindly about food and how delicious it can be and enjoying it. It looks like saying kind things about our own body and how it serves us and how I can celebrate with it.  It looks like intervening when negative body talk occurs with things like you are perfect just as you are.  The second point discussed is if you have a child who lives in a larger body, creating safety in that body by buying comfortable clothes and normalizing body variety.

Body shape and size is not based on individual work ethic as it is often portrayed but rather is based on a complex interweave of genetics, systems, and access to food.  As parents, we set our kids up for health by creating homes that allow for emotional expression and thus can minimize leaning on food to manage feelings.  We can help our children get access to joyful movement to increase health outcomes.  Research suggests that cardio fitness is much more closely tied to longevity than weight or BMI, and those are outdated ways of measuring health.

As we wrap up our conversation, we talk about how to best support ourselves as parents who are raising children in a fatphobic world and how to not only create safety for our kids but also how to heal our own history with our body and food in an effort to break generational cycles of diet culture.

Episode 66: Body Positive Teens with Dr. Jen Gaudiani

Unknown Speaker 0:01
Hi, Jen, thanks for joining us on The Family brain today.

Unknown Speaker 0:05
Thank you for having me, Megan. It's a delight to be back.

Unknown Speaker 0:08
I know that you were one of our early episodes. And it's funny because looking back, I think I said something to you, when you were on the beginning, I was like, Well, I'm gonna practice with you, because I know you. Meanwhile you have you're such a wealth of information, I should have practiced on someone else. But you were very generous to help me at the beginning.

Unknown Speaker 0:26
You've been amazing, then you're amazing now.

Unknown Speaker 0:29
Thank you. So one of the reasons I really wanted to have you back as we're doing this episode on parenting teenagers, and I wanted to talk a little bit about sort of nurturing healthy body image with teens. And then in conjunction with all of this happening, there was this thing that came about with Weight Watchers, creating an app for kids. And so then I saw you were in the mix with that sounds like this gives us so much to talk about. And I wonder if you could just remind people what you do in general, and then we can sort of move from there.

Unknown Speaker 1:02
Absolutely. I'm an internal medicine physician who specializes in eating disorders. And for about eight years, I was a leader of the top medical stabilization hospital program in the country for adults with critical anorexia nervosa. And for the last three years, I've had my own outpatient clinic, where we are telemedicine licensed in multiple states, and I see people of all ages, body shapes and sizes and genders, and really work on the medical aspects of their eating disorder, in conjunction with their home dietitian and therapist to help remove blockades and help them move forward and recovery.

Unknown Speaker 1:41
Yes, and I want to put this out there you are the real deal. Like I brag about you. Because no, but it's neat for me to see like I've had people who have said, Oh, my daughter went to this thing, she saved my daughter, like just randomly in my life. And so it's neat for me. So if you are struggling with an eating disorder in your family, call Jen because or Dr. gabbiani excuse me talk called Dr. Gowdy. Honey, because it's just neat. It's I mean, it makes me proud to be able to be like, I know, we're, so you're doing awesome work. But I'm excited to talk about like, so what what is interesting to me is I know you deal with very severe situations typically is my guess, right?

Unknown Speaker 2:19
Or well, actually, you know, certainly in my prior job, that was our thing. And I am not afraid of taking care of people with serious illness, for sure. But I see people from all, you know, have all degrees of eating disorders at this point, it's not, you know, it used to be sort of the sickest of the sick. And now, you know, I see people who just got diagnosed with an eating disorder, and their parents are like, Oh, my gosh, there's some stuff going on. And it's medical. And it's getting in the way. And what do we do, all the way through people who've been sick, you know, their whole lives and don't want to go back to treatment and want to find a pathway to survival. But but maybe need to find something a little bit more individualized. So I actually see the full gamut.

Unknown Speaker 3:03
And I will, that reminds me, I know you have a book called sick enough, which here I am being like, oh, who has to be sick enough. And I think that's something good to remind people that that you don't have to wait until you're in this critical position to seek help, or to learn more about how you can help people or help people in your family. And I guess I'm just curious about how we can help our kids in our parenting to try to sort of drown out some of these messages. So maybe you want to talk a little bit about this Kirbo thing. This is the app created by Weight Watchers. And I know you had a petition that you helped create health care providers against what is it against Kirbo? And and I just was wondering if you could talk a little bit about why things like this. Basically, it's an app that teaches kids some weightwatchers strategies like when to stop eating, what are kind of good foods, what are bad foods, how much exercise? Am I sort of? Yeah, but again, in a nutshell,

Unknown Speaker 4:05
it's a great jumping off place in order to talk about how parents might help their kids, we can start with what not to do Kirbo app is what not to do. So the Kirbo app was developed by WW the rebranded weightwatchers as a an app for eight to 18 year olds to lose weight. And you know, there's a lot of people in this country who would say, Okay, now Dr. G, we know that you're anti diet culture, we know that you are a weight inclusive body positive provider. But doesn't this country have a problem with some of the medical complications that go along with higher body weight? Why is this app a problem? Why shouldn't we be addressing this at young ages to prevent future problems? Well, the answer is that dieting never works. It doesn't work for adults. And it doesn't work for children, it is almost universally harmful. And what the Kirbo app does is assign a moral value red, yellow, or green to various different foods where milk is a yellow of all things. And it encourages children to monitor the steps of their exercise and to monitor what they're eating. And it gives them little bits of coaching. I certainly am a believer in health care for as many as can possibly access it. And Kirbo offers a paid extra option with quote unquote, coaches, who've done like a few hours of training,

Unknown Speaker 5:52
I just was looking at their coaches, and it's like, their background is economics. Like, that's interesting. Yeah, yeah. Why this person? Why am I listening to you? Yeah,

Unknown Speaker 6:02
then, you know, they also have pictures of before and after children who have so called lost weight. And you know, now I'm successful and happy and all this stuff. And so, one of my colleagues in the eating disorder field, pretend to try to register her 16 year old daughter, who happens to be quite tall and lean, if anything, they're always trying to get her to eat more to stay well, and, and keep, you know, going through puberty and becoming an adult. And she said, Let's just see what happens. So she pretended as if she were her daughter, she put in her daughter's name, date of birth, height, weight, and, you know, clicked whatever box that said, I want to lose weight. No problem, no parent, no checking, no, like, hey, whoa, why would somebody who has these specs want to lose weight? Nope. Straight into the app. So you know, that's a problem. But the biggest problem of all, Megan, is that dieting doesn't work. shaming people about their bodies doesn't work. There is a really misguided groupthink in this country, which emerges from constructs of privilege and power, because in this country, thinner people have more power. And, and so there's this belief that if you just do dot, dot, dot, your body will automatically become thin, privileged. And you'll be able to be your prettiest self, your happiest self, your most athletically successful self. This is all nonsense. This is not scientifically true. And furthermore, dieting slows our metabolism. And as we talked about, in our first episode, together, it lights up that part of our brain that developed during our evolution, that saves us from malnutrition, your brain doesn't know that you're quote unquote, just trying to take off five pounds, it goes, whoa, we must be in a low resource time, get that body going, let's make sure we slow the metabolism, slow the digestion, save body weight. And when we get back to food, let's make sure we put on a little extra so that we're safe the next time we go into one of these famines. So like, that is how we are biologically filled. Therefore, the old medical advice because frankly, this comes from doctors as much as it can, it's

Unknown Speaker 8:51
not even old. I just got this advice for it's not old. I mean, I'll tell you that story, finish what you're saying. But I felt empowered by what you had taught me to stand up for myself and my kids. Because it was well just tell you it was somebody not naming names with puberty? And I said, but he's going through puberty, like, aren't you supposed to gain like kind of a lot of weight because this is what your body does. And the woman was very dismissive of me. And I ended up talking to another person in the practice leader, but I felt empowered to know like, I had been taught that yeah, that's part and my son's face turned bright red. And but I had a great conversation with him on the way out to say you need to be an educated consumer, you know, like, you have to always just because someone is a doctor or has this power position, doesn't mean they're always right. And it's hard because you know, with kids, you teach them you want them to respect authority, you don't want them to be always likely you don't know anything, you know, you don't want them going around like that all the time. But when you have the research and you have people who are helping you understand better and when I went back, the woman the the main Dr was saying that there was a big push with the American Academy of Pediatrics to push down the obesity rates in our country. And it's just it's almost like we don't have the tools how, okay, that's fine that we don't want obese people, but like, how do we do that and shaming a child who's going through puberty seems like a real bad idea, you know,

Unknown Speaker 10:20
is not only is it unkind and immoral and unscientific, but it turns out to be likely to cause the exact opposite of what the pediatrician wants. So, so the real science and the real data show this, that when kids are made to feel bad about their appearance, and it doesn't even take a doctor, I mean, they walk on into a classroom, and, and they feel their classmates sort of watch, they know what you know, they know what they see on TV, they know what is being talked about on the playground, kids know, when they don't happen to occupy a body, or, you know, a facial features, or whatever it is that sort of hues to what's supposed to be ideal in this country, and what has power, what has privilege. When children are shamed about their bodies, when they're made to feel like they should restrict certain foods, that thing clicks in their brain, and they become more likely to secretly eat, to crave forbidden foods to eat too much of the foods that have been, you know, they've been told not to. And ultimately, those children have a higher risk of developing eating disorders. So you know, let's just take a mom whose kid is going through puberty. And you know, shockingly enough, not everybody's child goes through puberty, like somebody that you see on Nickelodeon, who sort of seems always to look perfect no matter what age they are. And tada, they're an adult. Yeah, no one does that, except for the point 1%. So you're a mom of a kid whose body is going through stuff. And a lot of the time adolescents go through a time where they are thicker, and that may mean that they're meant to be thicker people. And that's cool. That's great. I recently did a piece in Teen Vogue on or I contributed to a piece of Teen Vogue on the quote unquote, baby fat, which basically just stigmatizes the weight kids carry and implies, well, as long as you get rid of that, by the time you're an adult, it'll be okay. It's cute. Now, it won't be cute later. We have to really avoid that. So so let's say you're a mom. And you're like, Well, what the heck do I do Dr. G, because, like, I just want my kids to be well, I want them to have a healthy relationship with their body and with food. I want them to be able to, you know, date and not have body stigma. Well, the first thing we can do to safety that is to not have body stigma in our homes. So it is talking kindly about your own body, and your partner's body and your children's bodies. And it's about talking kindly about food. There's a great article right now. It says almost when people listen to this later, it's almost Halloween right now. Great article, The New York Times right now about Halloween candy that a few of my friends contributed to. And you know, it basically says, enjoy the magic and boisterousness of Halloween. Don't limit what they have for candy on Halloween. Or the next day, they'll sort of slow it down. And maybe By day three, you're like, great, you know, have a piece of lunch and a piece at dinner. And if you don't get all fussy about it, they're gonna lose interest. And that's exactly what happens in a healthy perspective only when things are restricted. And you know, focused on the kids sort of routinely overindulging this stuff. So the first thing is healthy homes, low weight stigma, low self stigma, kind body conversations, I'll share a story from my own parenting. My older daughter is almost 14 now. And maybe six months ago or so we were in my bathroom together, and we were just getting ready or we were, you know, doing hair I can't remember. And she looks in the mirror from her body to mine. And she goes, Oh, come on, Tim look like you. Look how much my body looks like yours. And I was like, Yeah, we're built really similarly. And it was a comment that she made that was completely devoid of fear or loathing or worry. And I just thought in that moment, thank you for putting me into this professional field. Because otherwise you know, like so many of my women friends, I would have gone around casually making negative comments about my body. Oh, this man I don't love that and that doesn't look that great and and then my daughter Hutter, who is perfect, and who has a body similar to mine would have thought, oh, there's a time capsule. Apparently this body is going to turn into something that's llove. Worthy. It's yeah, acceptable.

Unknown Speaker 15:15
It's very interesting. Being around, and I know you mentioned, I tried to be really aware of this. But then sometimes you're around groups of people like friends. And like you said, you know, your own friends or your kids friends. What do you do when you're in those circumstances? And you feel like you don't? I mean, I'm guessing you don't want to be like the police on this. But how do you have a technique to help, like, shift the conversation?

Unknown Speaker 15:44
Yeah, I mean, I think it helps that the people that I, when I hang out with people, they, for the most part, know how outspoken I am. And what I do, right. And so I'm actually pretty shameless. Now. I never want to shame someone, because they're just doing what people do to get along in society, unfortunately. But if someone says something, especially if my kids are listening, I feel like I have to say, oh, no, no, we're not going to have that conversation. Because you're gorgeous and perfect. And your body is great. Yeah, no, and just like or No, no, we're not going to do that. You're, you're wonderful. And also, little ears are listening. Right? Nope, your body's great. We don't ask that. You know, just I think it actually gives people permission to stop the reflexive negative self talk, when in doubt, particularly as women, but men do it to increasingly, you know, we're just shitty to ourselves. Yeah, I mean, um, and, and that has come to be a kind of way of just, I don't know from the feminist in me says that it's about women making sure no one thinks they're too full of themselves. They may be wonderfully accomplished and hardworking, and have gone through incredible challenges. But they don't want anyone to think they're too high on themselves, and they put themselves down. Yeah, yeah, we got to really get away from that, because we're raising girls, who are going to be the women of the future, who we don't want to have that negative opinion of, and boys who are going to be their friends and maybe their partners, whom we don't want them to have that opinion, either. So, you know, creating a pollution free space where you're like, oh, no, when we're with me, we order all the delicious food in the restaurant, we don't talk about calories, we don't talk about burning off our lunch. And we don't talk about the, you know, body dissatisfaction, unless it's a thoughtful, engaged, like, gosh, I'm really struggling along these lines, and it's with a trusted friend. Sure, you know, but so, so there's that there's that piece of it. And, and so parents are like, sweet, we, we've got a kid, and maybe, maybe you're raising a fat child, you know, like, let's say somebody's raising fat child, and that word fat is being increasingly reclaimed. For all of its positive, neutral descriptive features. Then, in that case, the parent of a fat kid has all the more responsibility to make home a super safe place for their child's body, to find clothing, which is hard, that fits and feels great. That creates a food culture in the house that is positive, balanced, emotionally engaged, you know, because their kid is going to face a lot of stigma in the world. And to be able to have conversations with a kid and say, wow, you know, it is a really unjust world where people have certain skin colors, who don't get certain privileges. There are people of certain body sizes that have a harder time of it. You know, in our family, we really believe in knowing people for who they are. And if you get words out there about your gorgeous body. Let's talk about it. Because there's nothing wrong with you, honey, you're just you're just right bodies come in all shapes and sizes. And health comes in all shapes and sizes. So you know, let's just enjoy this blessing of the body that you have. And we're going to go have fun in it and go outside and play and we're going to eat good food in our family and we're going to enjoy, you know, celebration foods. Those are the things that parents can do. It's not shaming your kid. It's not, God forbid giving them incentives to lose weight, which you know, is unfortunately not uncommon thing. It's not preferentially giving the sibling the ice cream, and giving your fat kid the fruit for dessert. If, and, and it's just preparing them for a world in which just like if your kid had, you know, any kind of disability where you prepare them for a world in which the world may not be as kind? And

Unknown Speaker 20:15
so are you saying that when there's a child who is heavier or fat child, that that's just how it's going to be? Or what? What are the factors that go into that. So say you have a child that is a bigger person, and that's something that worries you as a parent, you know, like, you don't want them to face that difficulty. What, what do you advise like, because I think a lot of parents put that back on themselves, Well, I must be doing something wrong. If this is not working out the same way it is for all these other people

Unknown Speaker 20:46
completely. Interestingly, the root of that guilt is in an individualistic perspective on weight that this country takes mistakenly, it's sort of every man for themselves, it's what you eat, and how you move. That's all that influences your weight. The reality is we're all embedded in systems in our in our lives. So if a child has, you know, we start with genetics, if you come from a family or your partner comes from a family of big people, there's a reasonable chance that your kid's going to be a bigger kid, then you can add in, you know, things that various families experience, maybe there was an early trauma in the family, maybe there's maybe grandma made body comments early on, that really stuck in your child's soul. And as a result, they started thinking they should eat differently, but just the thought of not eating sugar made them crave sugar, and so they went through kind of Vinji phase in their lives and their weight increased further, it's really important to say, we don't need an explanation for fatness necessarily, or for just body diversity. What we can do is say, I want to make sure that my kid knows how to move for joy, that's within ability and access to spaces to move, and interest, I want to be sure that my kid has a healthy relationship with food and with his emotions. Because the more we can allow the entire spectrum of emotions, you feel sad, you feel angry, you feel overwhelmed, you feel frustrated, you feel lonely, great, let's talk about it. Rather than let me numb with food, or for some people with caloric restriction. And I think what we have to understand is, if you're allowing for emotional space, and to the extent that you have the financial means to do so you're providing reasonable food and good portions and a reasonably balanced, you know, set of meals most of the time, and your kid has the chance to get some movement. That's the body they've got. They may not fit out. Okay? You know, just like very few people become supermodels. Because they're just sort of genetically speaking, that's just not in the cards. There are a lot of kids for whom it's just not going to be in the cards for them to occupy thin privilege. And then it's that it's that work on like, let's just make sure that you always feel like you're allowed to move in that body. Yes, you're allowed to be on the soccer team. Yeah, you're allowed to go do that other sport. Or maybe we say, let's find sports or activities you love to do, where you're gonna get a little less attention for the difference in your body size. But that makes you feel like Yeah, it's fun to move, because we know that movement has long term positives, in terms of cardiovascular benefit and independence and strength and things like that. In fact, what we know from the data are that independent of BMI being cardiovascularly fit is the best predictor of mortality. So a big veteran study was performed on over 30,000 veterans, and it showed that it was actually the men who were in the quote unquote, obese BMI range, who were the most cardiovascularly fit who lived the longest. So super interesting stuff. It is

Unknown Speaker 24:40
interesting. I just wonder how can we change the tools that are being used because that's what's frustrating to me. I mean, I was on my pulpit here talking about because they're weighing everybody with this scale and like it tells you nothing. Do you see how muscular my child is my child is I mean, you know, my family. You know, my my child is kind of a beat not a beast. But he's not gay best ways. Yeah, yeah. It's just it's, he's he's a really strong kid. And so like you put them on the scale, you don't know what you're weighing, you know. And so it's just amazing to me that we're at this point where we can like, order food and have it like dropped to our home. But yeah, the resources aren't there to measure health in a better way. Like, what is the deal? How can we change this?

Unknown Speaker 25:24
It's such a fantastic question. And I think it's what you're doing with this podcast. It's what I'm doing in my work. It's what those of us on the frontlines are trying to do to change the dialogue, to stop the school weighings to stop the idea that we can know from someone's appearance or from their weight, whether they're healthy or not, you know, the odds diminish that they're very, very, you know, sort of quintessentially healthy at the extremes of weight. But the fact is that you can't tell when you put your muscular kid who's going through puberty, who's going to have some extra, you know, weight on him. The idea that that just Denmark's how his health is, is absurd. And in the meantime, feeling shame, and that moment, teaches him to feel shame at the doctor, and be less likely to go check in with doctors regularly as he gets older. And it makes him feel shame about his body as if he's not getting 1000 messages a day. That it's the thin in the often in the boys case, it's the ripped, defined muscular ones who get all the goodies. I mean, this is like, a great example of this for our teenagers is shows with teenagers and movies with teenagers are cast with 24 year olds, as 17 year olds. I don't know if anybody's looked lately, but 24 year old guys look really different from 17 year old guys. Right? Well, you know, when when we look at these images, we think, Oh, is that what I'm supposed to look like? Is that what I'm supposed to be attracted to? When I look around at my age mates, that's not what I'm

Unknown Speaker 27:14
seeing. It's not what's happening here. The girls?

Unknown Speaker 27:16
Well, you know, and so, there's so many opportunities where our kids are getting the message that there's only one way to look, there's only one way to be healthy, when the reality is that humans are the largest mammal that can eat almost anything. And thrive. Giraffes can only eat Acacia shoots and leaves, that whales can only eat plankton, but humans across the globe. Oh my gosh, we can eat virtually anything. And create post weaned one year olds into adults were like the absolute off roading champs if the nutritional world on this planet were built for this. So this the various constructs of quote unquote healthy eating are really dangerous and dumb. Because everyone's version of healthy eating is assigned by arbitrary rules. And very, very little science right now healthy eating is low carb back in the 80s Healthy Eating was low fat low eggs be like No,

Unknown Speaker 28:28
it just makes you wonder what I mean, we're going to end up putting it into such a tunnel that we're going to be eating like the giraffes, like we only are allowed to eat this. Because it's like, you start to look and you're like, What am I supposed to feed if you can't do this, and you can't do that. And I it is interesting to me because I feel like even as an adult and I consider myself I mean, I try to stay on top of this stuff. But it's very hard to avoid those messages of like carbs and oh, are you making sure you're getting enough protein? And like you said, I try to remind myself like we are very hardy, resilient people, you know, we don't need to worry so much. And it's it's it's a tricky game, because I do think you'd like you were saying there's so much information coming towards us. That doesn't help us feel calm about it. Yeah, if anything, it's like, constant information to make us feel anxiety.

Unknown Speaker 29:21
That's correct. And I mean, that is a perfect marketing strategy. Making people anxious. Making sure that what's on the line is no less than whether your child will be accepted, loved and successful, is the perfect way to sell us products. We got to be really media savvy about why we're being sold this anxiety because it's not based in science. You know, people ate bread every morning for a zillion billion years and a bunch of different countries and turned out just fine but now oh my gosh, you know if you haven't got and your kid protein in the morning with their breakfast, they might not be able to.that.so That makes us really vulnerable. And the more we can challenge that, and kind of unplugged from the matrix and be like, No, wait a second, this is some bullshit. Yes, I know how to feed my children. And the way I feed my children is going to be congruent with my family's values, cultural background, you know, relationship with food. And I'm going to do that because I'm raising my child, you can raise your child, I'm going to raise my child. So I think the key is that when it comes to body image and raising healthy teams, the less neurotic we can make them, the more comfortable in their own skin, the more respectful of body diversity, the more understanding that virtually all food will get the job done. And yep, great fresh fruits and vegetables are awesome to add in at almost all times, the more they can understand that their emotions can be spoken, the more they understand that dieting, is a guaranteed highway to weight gain, not because there's something wrong with weight gain, if it happens naturally in someone who's in a bigger body. But we know that diet, dieting and weight cycling are super bad for health outcomes, they worsen all sorts of cardiovascular outcomes, people who are up and down and up and down. These are the things that we can bring to our kids. These are the things that are going to make them less fragile and less vulnerable. When they do hear their peer group go through some weird phase with food and they're like, Yo, whatever y'all are doing, I am not going to participate. Because I know from my parents, that this doesn't go well. He used the protective things we can do.

Transcribed by https://otter.ai

In this episode, we cover:

  • How diets do not work
  • Creating a safe body culture in our homes
  • Thin privilege
  • Positive self-talk about food and body
  • Self-acceptance, self-compassion, and kindness toward self
  • Breaking generational cycles of diet culture

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