Clinical Psychologist at the Yale School of Medicine, Professor Janet Lydecker, PhD talks about teens binge eating more since COVID.
Interview conducted by Ivanhoe Broadcast News in 2022.
Can you tell me what would you consider an eating disorder and what you and your colleagues at looking at?
LYDECKER: Sure. So officially an eating disorder is a diagnosis. So there are formal diagnoses and then there’s more of a catch-all category for things that are disturbing a child or an adult’s life, but aren’t quite how we would expect them. So most people have heard of anorexia, which is when kids or adults are not eating enough calories. And then again, most people have heard of bulimia, which is when there’s binge-eating episodes and purging episodes. One of the things I focus on more is binge-eating disorder. And most people haven’t heard of that because it’s newer. Binge-eating disorder is with the binge-eating episodes of feeling out of control and overeating, but not purging afterwards. And it’s very distressing and both kids and adults have it. It can be related to overweight or obesity, but it doesn’t have to be. The distress is really the key part. Distress and feeling out of control.
Are you and your colleagues seeing an increase in binge-eating disorder?
LYDECKER: Yeah.
How much of an increase can you give me some context?
LYDECKER: It’s hard to say exactly how much of an increase there has been. But since COVID, we have seen an increase in all of the eating disorders. So our clinic has been getting more calls for binge eating disorder than we did previously. It’s been across the board. So all ages, all genders, all races, there seems to have been an increase. But again, it’s hard to say exactly how much. And it’s hard to say if it’s- that more people are reaching out so they feel like they can and need to ask for help whereas they wouldn’t have previously or more people actually have eating disorders.
What’s causing that spike in the behavior?
LYDECKER: So stress is causing the increase. So when kids are more stressed, or adults, they look for ways to cope with the stress and there can be healthy ways of coping or unhealthy ways of coping. So what we’re thinking of this is an unhealthy way of coping with a really stressful time in kids lives and in the world. Which is why COVID in particular and remote schooling and the aftermath of just coming back to somewhat more normal life has been associated with an increase in eating disorders.
We’re not completely there but are we coming towards normal or are you still seeing the increase?
LYDECKER: No, this hasn’t gone away. Maybe it will someday I would love to see that. But it’s been stressful for kids to go back to school. They’re in a different setting. They’ve missed a year, sometimes two years, of being in person with their peers, and that’s stressful. So they’re really having a new environment. Some of them have switched schools in that time, some graduated from elementary to middle or from middle to high school. And that’s very stressful. And then academically, they’re having to make up time, if they fell behind during remote schooling.
What should parents be watching out for?
LYDECKER: Yeah. So in terms of what parents can look out for, it’s any time when the teen’s behavior changes. And that’s hard to say for teenagers because everything is stormy. Everything is a change in behavior. But when it seems to be around food, in particular around body image, that’s a time to start wondering and asking questions. So what I usually tell parents who are worried about detecting eating disorders, is that it’s better to have a process in place that feels normal in order to have an open door in case an eating disorder does pop up, rather than detecting and then intervening. So something like a regular check-in time with the teen, whether it’s family dinner or right before bed or when they get home from school, sometime when it’s just normal that you would ask what’s on your mind.
And you mentioned, after school, there is sometimes snack time for kids before the dinner time. What can parents look for that may spark an idea that there might be a problem?
LYDECKER: Any attempts at dieting or extreme changes in what kids are willing to eat. So an aversion to particularly fatty foods or takeout foods, things like refusing to eat, what the family eats, where’s that never used to be a problem. All of those could be signs. Talking about or seeming to obsess about food can often be related to anorexia in particular.
And you had mentioned opening the door, do you have any phrases, any suggestions for parents that aren’t sure where to start, how they could get started with that conversation?
LYDECKER: That’s always a hard one. It depends so much on the parent-child relationship, but I think as general as possible tends to be better. So teens are very sensitive to weight and body image. Most of us are. So asking questions that are too direct could actually make them feel they need to pull it into themselves rather than open up. And they might feel criticized or there’s a problem when in fact the parent doesn’t mean anything like that. They just want to ask and see what might be going on. So asking questions like, what’s going on with your friends these days? Or is there anything that’s coming up in school that you’ve noticed? Very general questions. Social media is always the good one. So what are you seeing on your feed these days? Or what do you think of the effects of social media? How do you feel after you’re looking at it for a while?
Are there any things that parents should watch out, in terms of binge eating that would suggest that there might be a problem? Is there any behavior or any signs?
LYDECKER: Yeah. So one of the signs have binge-eating is secretive eating. So it can be eating snacks that are available for the whole family, or it can be finding wrappers and evidence that the kid has maybe gone to a convenience store and picked up a bunch of snacks on their own. And I don’t mean one or two if it’s looking like it’s a pattern that they’re sneaking extra food, that they might feel shame around eating in front of others. All of those are behavioral signs.
You had mentioned secretive eating. What does that involve sneaking stuff of the fridge?
LYDECKER: Yeah. Sneaking stuff out of the fridge. Or we see for example going to a fast food restaurant, but then eating in the parking lot or going to the convenience store, but eating on the way home. So no one knows that there is extra food consumed. Parents usually know it’s happening. They usually have either seen some evidence or they’ve noticed that there’s some secretive behavior.
Is this treatment for binge eating?
LYDECKER: Yeah, that’s my area. So psychological treatment. So we have some good evidence that cognitive behavioral therapy works for all eating disorders. There’s some other approaches as well. We have a clinical trial that’s specifically looking at teenagers because usually it’s kids or adults and teenagers are neither. But there’s evidence overall that cognitive behavioral therapy is a good way to go.
Now, you had mentioned you have a research trial and it’s open to people across the country regarding is it weight and bullying.
LYDECKER: Yes.
Can you talk a little bit about that?
LYDECKER: Absolutely. So we actually have two clinical trials. One is just for binge eating. And then while we were doing this clinical trial, we heard from many of our patients that they had been bullied. And that’s when the binge eating or dieting started. And from that, we started a different clinical trial that focuses specifically on weight-related bullying. So when middle schoolers or high schoolers have been bullied because of their weight or appearance, made fun of, teased, excluded from social activities called names, anything along those lines.
Are you seeing an increase in that as well in the bullying?
LYDECKER: So we haven’t seen an increase in bullying necessarily. And in part that’s because kids we’re not in-person and a lot of the bullying does happen in-person. Cyberbullying has been happening this whole pandemic. It’s unclear whether that went up because social media use certainly went up. But we are seeing as kids return to school, that there is bullying that’s picked right back up, possibly at higher levels, but it’s unclear whether it’s just a return to where it was.
What is your goal? What information do you and your colleagues want to bring first of all, from the binge-eating trial?
LYDECKER: So for the binge-eating trial we want to learn whether cognitive behavioral therapy can effectively help kids stop binge eating entirely. So we do one hour per week therapy with the teenager and then parents come in about once a month and I’m saying come in, but it’s all virtual. So come into the Zoom room and that should we hope help the teen and also give them enough social support from their parents that the changes can be sustained over time.
And in terms of the weight in binge-eating trial?
LYDECKER: So that one is a bit more complicated. So because this is completely new in terms of treating it, we are trying to reduce the distress that comes with being bullied because of weight. So we know that the effects of bullying are very serious, there can be suicide attempts, certainly eating disorders, depression, anxiety, very serious consequences. But we don’t quite know, aside from preventing bullying, how to help the kids who have been bullied. And so that’s what we’re trying to do. So we’re trying in part to prevent eating disorders, but some of the kids already have symptoms of eating disorders, whether or not it’s a full diagnosis. And for them we’re trying to improve the distress and depression, but also improve body image and whatever symptoms they have of- of eating disorders.
How long are you recruiting people? How long do you anticipate that the trials will run, and when would you think that you might see results?
LYDECKER: So we are getting close to the end with both of them. We’re anticipating the end of this school year will be the end of both of the trials. And then we’ll hopefully know at that point whether it’s something that we’re going to continue treating and have a different idea and just take it and spin it off in a different way. Or if it doesn’t work, then I guess we’ll know that.
Are you still recruiting for both and are they going to join the first day of trials?
LYDECKER: So there are completely free. It’s open to anyone in the US who has either binge eating or has been bullied because of weight. So all genders, all races, all states.
What’s the age range?
LYDECKER: Age range is 11-17. So middle school and high school broadly speaking.
How long are you recruiting for? Until the end of school year?
LYDECKER: Until the end of the school year, most likely.
How impactful are these issues on our young people? And how much of a difference is this making and could this be a lifelong struggle if there’s no resolution?
LYDECKER: So great questions. So in terms of impact, these are very costly disorders debilitating. So when binge eating or other eating disorders are not treated, it changes every aspect of the child’s life and every aspect of the family life. So there’s more conflict at home, friendships tend to be more fraught or the child ends up isolating themselves. It really impacts every area. Medically certainly there are lots of problems that come along with eating disorders that can have lasting effects. In terms of how chronic the disorders are, we are in some ways in a good spot with teenagers, with children because we’re catching the eating disorder early in many cases. And when we do catch it early, we’re much more likely to be able to treat it and be done.
How important is it to catch these eating disorders early and get treatment?
LYDECKER: So in some ways we are in a good spot with teenagers because we’re catching the eating disorder early. And when we do, we’re much more likely to be able to treat it and be done with it and have the child live a completely normal life. With adults or with children who’ve had the eating disorder for a long time, it tends to get better with treatment, but there’s still some lingering either body image concerns or challenges with eating or challenges with being around people who are eating or talking about body image or weight that are always going to be a challenge. So we want to catch eating disorders as young as possible and as quickly after they emerge as possible.
Is there anything that you would want people to know?
LYDECKER: Always a good question. So I think with the weight bullying, I do want to emphasize that parents can help with the weight bullying just by, again, talking with their child and setting up a time to ask about whether they’re being treated unfairly or in a mean way by peers. And the parents can take action if they do know that their child is being bullied. So schools by and large have a zero tolerance policies, so the parent reaching out to the school when it’s safe to do so, and the child won’t have retaliation, that’s a great way to go. The one thing that we do hear from parents, or two things that we hear from parents that teens do not find helpful are taking away the phone. So parents initial reaction when there is cyberbullying or problematic social media use tends to be, well then I’m just going to take away the phone, you’re not going to have access to the space where you are being bullied. And what teens say is that’s actually harmful because it cuts me off from the helpful support that I also had. So I completely understand the reaction that parents have where they just want to protect their child and keep them- keep them close. But it ends up being in some ways more isolating, which is harmful for the teens. The other thing we hear is that both parents and teens try to just loose weight to stop the bullying. And while that again seems logical, it doesn’t stop the bullying because once the child is identified as a victim by their peers, they’re going to be bullied, if not for weight, then for something else. So they’re going to keep being the victim of bullying. And they’re going to feel helpless because they tried to do what they could and they’re going to take that blame onto themselves. It also can create that eating disorder when it’s a desperate attempt to lose weight, when they’re willing to do anything at all. And again, it’s reinforcing that idea that they’re to blame, which of course they’re not. It’s not ever the child’s fault for being bullied, it’s the perpetrator’s fault.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Colleen Moriarty
(203) 376-4237
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
