What’s new in eating disorder treatment?

We sat down with Jennifer Rollin, an eating disorder therapist and founder of The Eating Disorder Center based in Maryland, to find learn what’s new in the treatment of eating disorders.

1. What do you think has changed about the way we treat eating disorders in the past 10 years?

I think there have been a lot of changes in eating disorder treatment, and we still have a ways to go. One of the big things is a shift towards more evidence-based treatments. We now have a higher emphasis on treatments that have been demonstrated by research to be effective. This will hopefully lead to improved care.

We have also seen the incorporation of Health at Every SizeⓇ (HAESⓇ) principles into eating disorder treatment. We’re experiencing a push towards more weight-neutral care, and are reducing the fat phobia that has been deeply steeped into so many treatments in the past. Providers are finally recognizing is that eating disorders impact people of all body sizes. We’re working hard to eradicate fat phobia in the eating disorder treatment space because it is incredibly harmful.

I think some residential treatment centers are lagging behind, especially in terms of supporting males who have eating disorders. We have two local treatment centers, and only one of them accepts males. Residential treatment has a long way to go in terms of equalizing eating disorders in terms of gender, race, size, and abilities. We are seeing a shift in terms of providers being more welcoming to people of all shapes and sizes, but we still need a lot more education that people who have eating disorders can be any body size, race, class, and gender.

We still need a lot more progress in terms of being welcoming to people in all types of bodies. A lot of people who have eating disorders don’t ever seek treatment because they don’t fit the stereotype and don’t seek treatment or when they do, they are not treated appropriately. Diet culture has completely normalized disordered eating so people don’t even realize they have a problem. Larger people who have eating disorders are often seen as someone who’s trying to “be healthy” and “lose weight.”

2. How do you work with adolescents who have eating disorders?

The first thing that’s most important when working with anyone, but especially teenagers, is building a relationship. It can be hard to earn teens’ trust, especially if they don’t feel a connection with their therapist or healthcare provider. We can have all the best clinical skills in the world, but if we can’t connect with a teen, we won’t get buy-in or trust, and then we won’t be effective. Personally, I think it helps that I’m younger, and I work to keep in touch with teen trends so that they feel I can relate to their world and, therefore, their deepest struggles.

When we’re working with a teenager, we have the benefit of being able to work with the family, which can really help treatment. I will utilize the family in the treatment process as much as makes sense. We have to look closely at the family dynamic and determine the best way to work in partnership for optimal treatment.

Sometimes I will use modified Family Based Therapy (FBT), especially if I’m working with a younger child and it’s a purely restrictive eating disorder. I find it’s most helpful to modify eating disorder treatment for each child and each family system. Anybody who says that any one treatment is a panacea for eating disorders is problematic – we must look at each case individually. Not everything is appropriate for everyone, and not every family can or should take on FBT.

3. How do you involve parents in a child’s eating disorder treatment?

This totally depends on the person and the situation. I always share with parents that they can be involved as much or as little as they want. Sometimes I need to push for more involvement if I feel it will serve the child’s recovery. I am the child’s therapist, but I will send weekly email updates to parents, and I encourage parents to email updates to me so that I can be aware of what’s going on at home. I will invite parents into sessions and sometimes do family sessions, depending on what makes the most sense. But I always remain aware that my client is the child.

It can be very tricky to navigate fat phobia and diet culture. Parents are so well-intentioned and love their kids, but I can still see that they are trapped in our societal expectations regarding weight. A HAES-informed recovery process involves accepting the body as it is, but I still have great parents asking whether they can help the child lose weight in a healthy way. This is where we still have a lot of catching up to do in terms of educating people about the futility and dangers of intentional weight loss.

When treating a child who has an eating disorder, I become very aware of parents’ thoughts about weight. I take a gentle educational approach and tell parents that in my professional opinion, any focus on weight loss is not helpful for anyone, especially someone who is in recovery for an eating disorder. I know parents want what’s best for their kids, and diet culture has convinced them that certain foods are bad or higher weights are bad. Parents just want to do the right thing, but unfortunately, even though they are trying to help, they don’t understand that it can hurt.

I sometimes recommend that parents meet with a HAES-informed dietician who can help them understand these concepts. The analogy is that having diet foods in the house, talking about dieting, and focusing on weight loss is like going on an alcohol bender while living with someone who is in recovery for alcoholism. We have to be mindful of what we do when we live with someone who is in recovery.

4. What do you think parents most commonly misunderstand about a child’s eating disorder?

I think the most common misunderstanding is that an eating disorder is a choice. Even if parents have been told that it’s not a choice, it’s hard to accept that. We naturally want to understand responsibility and want kids to recover. Well-intentioned parents may feel upset when a child doesn’t follow a recovery plan exactly, they will say things like “you have all these skills, why aren’t you using them?” But this is where it gets tricky. An eating disorder is not a choice, but recovery is. This means that the eating disorder can slip in at any time and take over, and a person who is in recovery has to exert tremendous effort to constantly make the choice to recover. It’s so helpful to know that recovery is a process, not an event. And recovery looks different for every single person.

Of course you’re concerned about your child, and of course you’re disappointed when you see them struggling. But parents need to understand that they are going to have these feelings, but they don’t always need to say them out loud, especially with their child. Disappointment is normal, but parents can unintentionally make kids feel they are disappointed in them for struggling.

I have some clients who feel very guilty for making their parents’ life complicated and scaring them. And it’s true that parents do have to work harder when a kid has an eating disorder, but if the child had cancer, the parent would do it and recognize it wasn’t the child’s fault that they have cancer. That’s what I’d love to see when a child has an eating disorder.

I see some parents who are resigned to the idea that their child will always be sick. Then I have parents who think that if the weight is fine, the child is fine. We have to find a balance and recognize that you can’t judge an eating disorder based on someone’s physicality. Ultimately it’s a mental illness, and we can’t tell how healthy someone is based on how they look or their behaviors.

5. What is advice would you give a parent who has a child who has an eating disorder?

First, have compassion for yourself. A lot of parents blame themselves for a child getting sick. It’s natural to think about what could have been done differently, but ultimately parents have to move forward. Make time for your own self-care. Helping someone in recovery can be emotionally draining.

Second, have compassion for your child, and have compassion for the eating disorder behaviors. Sometimes eating disorder behaviors are the best way your kid can cope in the moment. The eating disorder is serving a purpose for them, otherwise they wouldn’t’ have it. Your child is trying to help themselves – they’re just going about it in a way that is not helpful.

Clearly, I’m passionate about helping people to recover from eating disorders, but I also believe in starting with radical acceptance, which is a concept in Dialectical Behavior Therapy (DBT). Acceptance doesn’t mean you like it, it just means you acknowledge it’s there and you don’t have to make it the enemy. The eating disorder is currently a part of your child. When we make it the enemy, it can feel disapproving or critical to the person. Instead, seek ways to reduce anxiety and help your child meet the needs that their eating disorder is currently meeting, in other more life-affirming ways.

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See Our Eating Disorder Treatment Guide For Parents