Amanda Wilde (Host): This is Children's Health Checkup where we answer parents' most common questions about race. Healthy and happy kids. I'm Amanda Wild. While eating disorders affect millions of youth, they're often undetected in early stages. In this insightful episode, we'll explore the warning signs of Eating disorders in children with Gabby Clarke, clinical dietician for the Center for Pediatric Eating Disorders at Children's Health.

We'll dive into what eating disorders look like in kids. The red flags to watch out for and how to nurture a positive view of food and body image at home. Gabby, welcome to the podcast. Thank you so much for being here and sharing your expertise.

Gabriella Clarke, MS, RD, LD: Thank you guys for having me.

Amanda Wilde (Host): Can you give a brief overview of what eating disorders affect children?

Gabriella Clarke, MS, RD, LD: Yes. So there's, quite a number, but I'll hit on kind of the main four that we typically see, especially in our program. so the first one that we see most frequently is, anorexia nervosa. This is kind of, I think what most people think about when they think of eating disorders.

So kids that really struggle with eating enough for their body. Maybe they're eating some, but it's maybe like 10% or 20% of what their body needs. they're worried about their body image and they often have what I call body distortion. So they think they're much larger than their body actually is.

and they're very fearful of gaining weight. So we see a lot of anorexia nervosa across kids. Bulimia nervosa is where kids are eating. They may look like they're eating appropriate amounts and throughout the day, but they're struggling maybe with large volumes of eating, in secrecy. So binge eating, and they'll do that later in the day or earlier in the day when, families are not aware.

And then they'll, have some sort of what we call compensatory behavior where they, Feel very guilty for what they've consumed, and they'll either have themselves throw up or, exercise in order to burn it off or use laxatives, diuretics, things like that. we also, will see kids with what we call, Avoidant restrictive food intake disorder or arf fed.

It's kind of a long one. that's why we call it arf fed. So that one, is for kids who really struggle, with food in its of itself. They really struggle to get enough intake in and they're really worried about the sensory texture components of food. Maybe they're worried about food, is gonna make me throw up, or food is gonna make me feel like I'm choking, so I don't want to eat.

we tend to see kids struggle with this, in the population. so we'll see kids with arfid. And then finally we'll see kids with binge eating disorder. so kids that struggle to eat, appropriate volumes throughout the day, maybe they're not eating enough and then they eat a large amount, typically in secret, and feel like they're overeating.

So we'll see kind of all those different ones and some are body image related, but AIT is not body image related and still an eating disorder.

Amanda Wilde (Host): So since some of these behaviors, or most of them are being hidden from everyone else, what are some common warning signs of an eating disorder that parents might overlook?

Gabriella Clarke, MS, RD, LD: I think that's a really great question. kids that are tending to eat more in. Private or eat in secrecy. Maybe they're leaving the table from family meals. They want to eat in their room, they want to eat in isolation. They stop going out to eat with friends. they're kind of avoiding those social food related experiences.

We're not willing to go to the restaurant with family anymore. and I know it's hard to even catch this one, but like excessive phone time can be one. I mean, that's, really hard to pin down exactly what excessive phone time means. But if they're watching a lot of videos.

On people and what they're eating or people, in their grocery trips or what we call like the what I eat in a day. Videos. A lot of that content on social media, can be very telling of what the kids are experiencing. even kids that are in the pantry and organizing and getting very involved in cooking when they weren't previously involved, like a sudden sparked interest in participating in cooking, preparing, making sure we're not using too much oil in the foods, making sure we're kind of micromanaging.

that kind of thing. can all be little signs that you wouldn't necessarily think of.

Amanda Wilde (Host): Yeah, those are really good tips for signs to watch out for. How are eating disorders diagnosed in children?

Gabriella Clarke, MS, RD, LD: eating disorders can be diagnosed by a variety of different providers, but I would say most commonly what we see is that kids will, go to their, well check from their pediatrician and we see something on the growth chart that's not looking quite what it was. or if families are concerned about eating disorder behaviors, bringing them to the pediatrician to kind of get a look, make sure we're getting some labs.

Seeing what's going on with the kiddos. So that can be one way. Another way is if, children are already in therapy or seeing a therapist or psychiatrist, those professionals are also very qualified to diagnose an eating disorder and provide treatment.

Amanda Wilde (Host): And what role does a dietician play in this treatment?

Gabriella Clarke, MS, RD, LD: so dieticians, are very involved in the treatment of eating disorders. we provide, what we call like a meal plan or education on kind of what the kiddo's needs are and how we can best meet those for the child. we're gonna also help them to kind of create what. I like to call a healthy relationship with food.

So not necessarily those strict labeling of foods as, I can never eat this or I can always eat this. kids tend to be very concrete and literal. So we wanna give them that language of we can eat all of these different things and our body needs all of these different things in different amounts.

Amanda Wilde (Host): So it's really about helping kids view food maybe in a different way.

Gabriella Clarke, MS, RD, LD: Yes, a lot more neutral and a lot more just for what it is and not, maybe so much of the moral value that sometimes can get assigned to it.

Amanda Wilde (Host): How do eating disorders differ in presentation between boys and girls or different age groups?

Gabriella Clarke, MS, RD, LD: in boys and girls, you know, if you asked me this 10 years ago, I think my answer would've been very clear in that in boys we tend to see more of that focus on muscularity or muscle building, getting in the gym, wanting a specific physique, and girls tend to always just kind of want to make their body smaller, thinner.

It's not about muscle, it's just about smallness. However, in the last. To five to 10 years. I think we've seen more of a push, even for boys to just have more of that focus on smallness versus muscularity. so it's kind of shifted throughout the seasons, but we see that in boys and girls.

We also see, I mentioned earlier, the avoidant restrictive food intake disorder. That sensory piece with food is very commonly seen in autism, and autism is more frequently diagnosed in boys. So we do see a higher population of boys with a i in our programs, versus girls. So that's kinda one of the things we've noticed.

as far as gender pieces, the other piece, I think we'd be earnest to miss it. but we do see a lot of kids, with, gender identity exploration and within that, there tends to be an avoidance of wanting to, develop. And so we may. See a restricted intake in those kids.

I know the Trevor Project, is one of the references I like to throw out there in that in 2022 they found that 87% of L-G-B-T-Q youth were having body dissatisfaction. So the gender piece can definitely play a role in, the development of eating disorders. And then as far as for kids, across age groups in the younger kids, we tend to see with traditional eating disorders, there's a lack of wanting to grow up.

They wanna stay smaller. they may eat just less of the foods that they've always eaten. So they're eating the cheeses, they're eating the Doritos, but they're only eating a handful instead of a bowl, or they're only eating a few here and there. So it's a little bit harder to catch versus the older teens.

We're gonna see a significant marked increase in. I'm no longer going to eat carbohydrates. I'm no longer eating fats, I'm only eating protein, or kind of those specific foods.

Amanda Wilde (Host): Well, America in general seems obsessed with weight and size, and I know diet culture has played a role in the development of eating disorders. how do you see. Both the diet, culture and then social media, which is a relatively new piece. What role do these play in the masking of eating disorders or the development of eating disorders?

Gabriella Clarke, MS, RD, LD: I think this is my favorite question because, we live in the world that is very focused on body weight, shape, size. I mean, just going to the Thanksgiving table, you're gonna talk about. Everything you've eaten and what you feel like you need to burn off and this, that, and the other.

And so it's so hard to catch these things for kids because a lot of the times it starts as them just wanting to eat healthier. You know, air quotes, like they just wanted to like eat healthier or burn off things. so not knowing what's. Normal versus, when does it turn into a disorder can be difficult.

so I think it gets masked in the intermittent fasting of the world, the exercise of the world, so can be very, very difficult and is a huge contributor. I mean, I think I always bring up the fact that like even just going into the grocery store, you find chips that say reduce.

Guilt or, you know, high protein Pop-Tarts and things like that. like kids see that. And like I said earlier, they're very concrete and very literal. So those messages are, really taken home and I think it does, impact the kids. And I think social media is just a host of that.

and I think, you know, the kids especially, being on their phones more and not. parents not necessarily knowing what the kids are viewing can be a contributing factor. So really being aware of the content that the kids are consuming. And if you see a lot of the, what I eat in a day videos, a lot of the healthy, clean recipes, any of those, hashtag healthy, hashtag clean fitness, you know, all that kind of stuff.

once again, we think it's a positive thing and it can be, but it can also become disordered very quickly.

Amanda Wilde (Host): So you really need to have a handle on what your child is consuming, both food-wise, but also on social media.

Gabriella Clarke, MS, RD, LD: exactly.

Amanda Wilde (Host): If a parent suspects their child might have an eating disorder, what should they do?

Gabriella Clarke, MS, RD, LD: I think the first step is, making sure that they've got a pediatrician or provider on board, so taking the child to the pediatrician, asking them to, get some updated labs. Ask all the questions, just kind of take a look at things and, they'll be able to provide them with resources for, treatment as necessary.

Right? So the therapist, the dietician, the outpatient team that can help support their kiddo.

Amanda Wilde (Host): And lastly, what. What proactive steps can parents take to foster a healthy relationship with food and body, especially in light of what we just discussed, all the competing pressures.

Gabriella Clarke, MS, RD, LD: Yes, it can be so tricky. I think family meals are one of the most protective. things that we can do to fight eating disorders. I think really just being together while eating, promoting that we can all eat together, having a variety of foods. So sitting together and seeing what the kiddos are eating and having them see you eat appropriate portions is super helpful.

I also think. Our words holds a lot. and so what we're saying about ourselves or what we're saying about people at the mall or people on tv, trying not to comment, so much on people's weights or food intake or things like that. Um, it can be so, so hard to kind of monitor that.

But I think kids are always listening and always watching. So we're saying, oh, I don't like my arms, or, oh, I wish I, you know, fit into this different, Genetics play a huge role in body development and so just making sure we're speaking kindly to ourselves and having a healthy relationship with ourselves, as parents, I think can be super helpful.

Amanda Wilde (Host): Gabby Clark, thank you for sharing your expertise as a clinical dietician who's worked with this issue. I really appreciate your time.

Gabriella Clarke, MS, RD, LD: Yeah. Thank you so much for having me.

Amanda Wilde (Host): For more information, visit children's dot com slash eating disorders. Thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels.