Melrose Heals: A conversation about eating disorders

Episode 10 - ARFID

Episode Summary

On this episode, Dr. Karen Nelson is joined by Dr. Marcus Westerman, MD, PhD, a psychiatrist at Melrose Center. Marcus and Karen will talk about ARFID which stands for Avoidant Restrictive Food Intake Disorder. ARFID isn't just about picky eating and for those suffering, it can impact both their mental and physical well-being. But recovery is possible. Marcus and Karen will talk about signs and symptoms and offer support and encouragement for both those in recovery from ARFID as well as their family and friends.

Episode Notes

On this episode, Dr. Karen Nelson is joined by Dr. Marcus Westerman, MD, PhD, a psychiatrist at Melrose Center.  Marcus and Karen will talk about ARFID which stands for Avoidant Restrictive Food Intake Disorder. ARFID isn't just about picky eating and for those suffering, it can impact both their mental and physical well-being. But recovery is possible.  Marcus and Karen will talk about signs and symptoms and offer support and encouragement for both those in recovery from ARFID as well as their family and friends.  Click here for a transcript of this episode. 

Episode Transcription

Dr. Karen Nelson  00:02

Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that will find the opportunity for healing. Hi there, I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose Center, welcoming you to Melrose Heals, a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Dr. Marcus Westerman, a psychiatrist here at Melrose. Marcus and I will talk about ARFID, which stands for avoidant restrictive food intake disorder. This isn't just about picky eating, ARFID can impact someone on a much larger scale, where they become fearful or avoidant of certain foods. This can directly impact both their mental and physical well being, but recovery is possible. We'll talk about signs and symptoms and offer support and encouragement for both those in recovery from ARFID, as well as their family and friends. Now, before I begin, I invite you to take a deep breath and join me in this space. 

 

Well, welcome to the podcast Marcus, I'm so excited you're here with me today. We're going to be having a discussion about ARFID, which stands for avoidant restrictive food intake disorder can be quite a mouthful. But actually, before we get into that conversation, I would love it if you could introduce yourself.

 

Dr. Marcus Westerman 01:37

Yeah, I'm excited to be here. My name is Marcus Westerman. I am a psychiatrist at Melrose Center. I work primarily with kids and adolescents, and I've been working here for almost 11 years.

 

Dr. Karen Nelson  01:51

As we transition and talk about specifically this diagnosis of ARFID, this acronym--and it's a long name right? And I'll be honest, sometimes I even get the words wrong: Avoidant restrictive food intake disorder. And I'm an eating disorder specialist! I think that that can, you know, speak to maybe some either misunderstanding of the diagnosis, or maybe not even really knowing or understanding that this can be an issue for people. So I would love it if we could start by exploring and defining what is ARFID?

 

Dr. Marcus Westerman 02:27

Yeah, I agree with you. It's a long name, avoidant restrictive food intake disorder, I think ARFID is more fun to say. It's a relatively new diagnosis. It's not that it's a new presentation of eating disorder problems, but just defining it. So what avoidant restrictive food intake disorder means is it's a food avoidance or restriction leading to some sort of persistent failure to meet nutritional needs, which then may result in weight loss or failure to grow on your kind of normal growth curve, having specific nutritional deficiencies or having some psychosocial impairment related to eating. So problems with eating and social settings and things like that.

 

Dr. Karen Nelson  03:14

So let's maybe talk about how it may present or show up. It's my understanding that there may be kind of three different kind of ways that we might see ARFID express itself.

 

Dr. Marcus Westerman 03:27

Yeah, there, there are three common types of ARFID. So the first is food selectivity due to some sort of sensory sensitivity. The second is a lack of interest in food or eating and the third is what we call fear of aversive consequences or some sort of negative event happening related to eating be it like choking or vomiting. So you know, with the first type of sensory sensitivity that you would have a very selective eating pattern. So kids or adults would have only eat certain foods, or avoid certain types of foods, have difficulty with types of food, be it crunchy, or mushy, or those kinds of things. Lack of interest in food or eating is where they're really just not prioritizing eating, they're distracted doing other things, they may miss meals, they just might not eat very much, sort of smaller amounts or have kind of a chronic low appetite. And again, the fear of like a negative consequence would be you know, after having an event such as like choking on food or vomiting after eating that they might associate food and eating with something being very fearful. So they may avoid that because they're afraid that something bad might happen. Sometimes it can happen with worries about allergic reactions to that's you know, a more common thing recently that sometimes if people have an allergic reaction they may be fearful of eating going forward.

 

Dr. Karen Nelson  04:55

Sometimes I hear as patients or friends or family hear the description Have are fed, sometimes they may respond back like, ‘Oh, so you mean a picky eater.’ And help us understand is ARFID picky eating?

 

Dr. Marcus Westerman 05:09

So the difference between picky eating versus ARFID is that for ARFID, you really have a failure to meet nutritional needs, right? So there's a functional impairment either in terms of weight loss, or lack of normal growth, nutritional deficiencies, or pretty significant psychosocial impairments, such as, you know, problems with eating and social situations or things like that. So picky eating, you know, is certainly a problem that people can have, kind of a selective eating pattern. But for ARFID, the distinction is really that it affects something more significant in your life, either physically in terms of weight and growth, or psychosocially, in terms of affecting social situations,

 

Dr. Karen Nelson  06:03

That must be really hard for patients, I would imagine. Maybe isolating or lonely, it potentially can feel, if I can engage with certain types of foods, does that ever come up? Or what do you think?

 

Dr. Marcus Westerman 06:15

Yeah, absolutely, it can really be a devastating illness. We think about food in terms of the nutritional aspect, and the caloric intake and things like that. But we have to keep in mind how social food is, I mean, it really is a social glue, if you think of holidays or things like that, and they all have some sort of associated food. If you go to a party, usually the main thing you're doing is eating or getting pizza, or things like that. Or if you're going out with your friends, you might want to be getting food, getting coffee, like all those kinds of things. So when a person feels fearful and anxious about food and eating, they will oftentimes avoid those situations, and then they’re really kind of left out of a lot of really important social things.

 

Dr. Karen Nelson  07:05

What really comes up for me, as I hear you describing that is that that interaction between the behavior and the emotion, kind of the biology that that might be happening, but then also that, like you said, the social component. And how isolating and maybe sad or depressed, I could feel if I'm struggling with this.

 

Dr. Marcus Westerman 07:26

Yeah, definitely. And I think, you know, the connection between again, the mind and the body is so important. And oftentimes, you know, with eating disorders with kids and adolescents, there is a bit of a perfect storm, you know. As they're eating less, they get less hungry, they get full, quicker, they get full with smaller amounts of food. And often with ARFID, we see that these things will worsen over time. So as they're losing weight, anxiety tends to increase, they tend to be more sad. So biologically, that lack of nutrition can really affect behavior, thoughts, you know, with anxiety, increasing, the tendency is to try to, you know, make things more comfortable, right? So you may try to control your environment more. So you might restrict the variety of what you're eating even more, and your appetite might decline even further, or your fear of something bad happening, like nausea, choking, or vomiting may increase over time. So we often see that even though you might start to see a problem, you know, at one point, it tends to kind of worsen over time, and the selectivity, or the avoidance of eating tends to increase. 

 

Dr. Karen Nelson  08:41

So we've been talking about the experience of ARFID in children. So is this a disorder that only impacts children? Or can it impact people of all ages?

 

Dr. Marcus Westerman 08:51

Definitely can impact people of all ages. I would say most of the time, it's not uncommon for it to start in childhood or early childhood. Oftentimes, you know, given that it's a relatively new diagnosis, we'll have adults that will say, you know, ‘Yeah, I have a real problem. And I've noticed that this has been a problem going back to a young age.’ It's pretty common. We tend to see younger kids a lot of times, but then oftentimes, we'll see teenagers that will say, ‘You know what, this is really affecting my life, I'd really like to be able to go to a pizza party with my friends, I'd really like to be able to go on a date, and try some new foods and things like that.’ So they'll recognize, ‘Hey, this has been a problem. I'd really like to work on it.’ And the same thing can be said for adults, too, that, you know, they know that this has been something that they've struggled with for a while and they kind of have seen how negatively it's affected their life. So they really want to try to get some help. 

 

Dr. Karen Nelson  09:48

Do we know, is body image a component of struggling with the diagnosis of ARFID?

 

Dr. Marcus Westerman 09:55

That's a really important question because the thing that really distinguishes ARFID from the other eating disorders, particularly anorexia and bulimia, is that it doesn't have body image concerns, that there is not a concern or an intent to lose weight, or any fear of gaining weight. Oftentimes, actually, adults and kids and adolescents with ARFID are actually very motivated and want to restore weight, and want to be eating with a bigger variety and eating more consistently.

 

Dr. Karen Nelson  10:28

If we now potentially transition and talk about if it's been determined, or if I have been diagnosed with ARFID, what is the recommended treatment?

 

Dr. Marcus Westerman 10:40

In terms of treatment, at Melrose, we take a really a team approach. So the patient will work with a therapist, a dietician, a medical provider, and a psychiatrist, like myself, if indicated. At Melrose, we utilize something called cognitive behavioral therapy for ARFID or CBTAR. This is a relatively new treatment approach. So really specific approach for ARFID, which I think is important. You know, given the differences between ARFID and other eating disorders, I like to call it sort of eating lessons. Like just like you might take, you know, drum lessons or violin lessons you work with a therapist to kind of practice what the things are that you might need to work on with your eating. Either expanding variety, or working on a more consistent eating pattern to help with appetite and interest in eating, or to help challenge some of those fears related to things that you might have, like choking or vomiting. So it's a really a gradual approach. It's really fun, kind of working with both the patient and families to try to work on the problems that they're having with eating.

 

Dr. Karen Nelson 11:55

So if I'm a patient, and I hear the words, ‘expand variety,’ is that just code for you're going to make me eat food that I don't like?

 

Dr. Marcus Westerman 12:07

Well, I think I like to think of it this way, it's more that you're finding more foods that you do like. I mean, when it comes down to it, yes, there are certain things that you may not like. I don't like watermelon. People think I'm crazy. Everybody likes watermelon. I don't like watermelon. But that doesn't mean you know, I don't try new foods. And you know, if I go to a different country, I might try some different types of food, or I go to a new restaurant, and I'm excited to get some new experiences with food and tastes. I think that's really what we're working on in terms of helping people with ARFID. It's not necessarily saying, ‘Okay, we're going to make you eat food that you don't like.’ It's helping you learn how to try new things, and to not let anxiety or worry about that get in the way. 

 

Dr. Karen Nelson  12:58

Well, I like that description about the kind of practice of eating is kind of what I hear you talking about. And that this treatment is goal oriented, and it is structured, and as a team here, we're, we're here to support you with that.

 

Dr. Marcus Westerman 13:15

Yeah, and I mean, I've worked with patients, and honestly, like I said, it's really fun. Because on the one hand, yeah, there can be some emotions, there can be some tears. You know, I always put it this way, if you do take drum lessons, there are gonna be some lessons that don't go as well as others. But if you stick with it, you're gonna be a pretty good drummer by the end of the year, right? I mean, there's sometimes you're really gonna want to go to lessons, you're gonna like, ‘That one went really great. And I had a lot of fun.’ Sometimes, you know, again, it can be hard at times. But, you know, the treatment for anxiety is really what we call exposure and habituation. That just means you are getting, you know, getting practice. I think, for ARFID, it's, you know, often kind of staying in the comfort zone, right? And I always think of it this way, like, your body's default is to kind of stay comfortable, and really, you're not ever going to do anything, unless you have a little bit of a degree of discomfort, or a little bit of working on the unexpected, right? 

 

So I think with ARFID, oftentimes, the default is to stick with those comfort foods, to stick with those foods that they're familiar with. I mean, we sometimes use the term “fear foods.” And you know, I just put it this way, like I don't want food to ever be fearful. I mean, it's not gonna bite you or something, right? All food is good. So it's a question of just kind of practicing and, you know, expanding that variety, and being able to get out of your comfort zone. Again, sort of getting used to some change. And again, us allowing you to do that, you know, I just put it this way--fear and excitement are kind of different sides of the same coin. Now we have joy, when things are unexpected, a comedy is funny because it's unexpected. We also like horror movies because horror movies are unexpected, right? So when it comes down to it, like I said, that joy and excitement with food really comes from trying new things. But also, eating more regularly, eating more consistently, not letting fear and anxiety get in the way of your life.

 

Dr. Karen Nelson  15:34

The theme that really comes up for me is that aspect again of isolation or loneliness, you know. A lot of my patients who might be even struggling with anorexia, bulimia, binge eating, they talk about almost the secretiveness of it. Or sometimes the minimization of it. ‘Oh, it's no big deal,’ or ‘I don't want to talk about it.’ So having the space to maybe bring it up with a doctor, or bring it up with a therapist, that this is causing maybe some distress, sounds like it can be important.

 

Dr. Marcus Westerman 16:05

And like I said, I think it can have those physical consequences, but again, those psychosocial consequences. Because I think a lot of times people come to treatment because they've noticed the problem physically that they've had, but they minimize how much, or they don't even understand how much this is affecting their life.

 

Dr. Karen Nelson  16:28

Well, it sounds like having some discussions with patients about how you will help them face their fear, right? I mean, I think sometimes there, again, is maybe some minimization of some of the struggle that our patients have—‘Oh, just do it.’ Right, like, you know, and maybe parents might get frustrated, like, ‘Just eat the carrot.’ And it's like, it's not always just about the carrot, right? Like, it's not that

 

Dr. Marcus Westerman 16:52

Understanding that anxiety is not just your thoughts. I mean, there's a physical component to this. When you've avoided things for a period of time, I think that's often where kids or teenagers particularly may be really fearful of trying new things, because they've had choking episodes, or they've had gagging episodes. And that can be really embarrassing that their body reacts in that way. You know, I'm not the biggest fan of heights, and I've had some situations where my body--I want to do it, I know this thing is safe--but my body just crumbles like a leaf, right? That same experience associated with meals and with food can be really scary. I mean, it's really out of your control. And just understanding that, again, we're going to be doing this in a safe space, where you're going to be doing this in a place where people understand what you're going through, and know how to work on that know how to help you with those skills. But also, you know, again, understanding that it's going to be hard at times, and there may be things that, you know, might feel embarrassing to talk about or to try. But also that that's helping you toward getting better and getting practice in a way. What we are at Melrose, we are a place that you can you can mess up and you can you can go through some of those difficult things, because we understand and we know how to help you through it.

 

Dr. Karen Nelson  18:21

Well, I love that aspect of really encouraging patients that, you know, treatment happens in community, and that we're here to support you. That it isn't about perfection, it's about experimentation and curiosity. And your team is there to explore with you, what were the hard parts? And, you know, having some conversations about that, that can feel reassuring, I would imagine.

 

Dr. Marcus Westerman 18:47

And I think you know, when you are in those sessions, and you're going through kind of evaluating how you're feeling, what is your anxiety level, at this time? Getting some, you know, encouragement, and also some proof that, ‘Hey, the first time I did this, my anxiety was through the roof, but the second time wasn't nearly as bad.’ 

 

I always tell people if you have a really--you know, you could have a full blown panic attack the first time you're trying something new. It could be the worst experience in your entire life. And unfortunately, if that is then associated with never doing that thing again, then you've lost all that work that you went through, right? You already went through the worst part, right? The next time you do it, it's not gonna be nearly as bad, and the third time, it's going to be way better. By the 10th time, it might be the most fun thing you ever do. Right? I mean, that could be a new thing for you in life. So you know, not being fearful of anxiety, not letting it get in the way. Because I think a lot of times parents will come in and say, ‘Yeah, you know, my kid is so anxious around food. Is there something we can do to get rid of that anxiety and then that would help them eat?’ And the way I always put it is, ‘We're not, we're not trying to get rid of anxiety in order to eat, we're eating in order to get rid of anxiety.’

 

Dr. Karen Nelson  20:14

Let's talk about strategies for eating enough. So if a patient is coming in to a session and starting CBTAR, are there specific strategies that you may talk with families about making sure that their child is eating enough?

 

Dr. Marcus Westerman 20:31

You know, in terms of the first part of treatment, one of the most important things that we're working on is getting a patient to eat enough. And often it is related to some restoration of weight, and maybe increasing what they're doing what they're eating. Because oftentimes, as you're eating less, your digestive system, kind of, like I said, sort of slows down shrinks up. So your body gets used to eating smaller amounts of food. I mean, I could say, you could generalize eating disorder treatment by saying we're trying to help you feel physically--which includes emotionally because your brain is an organ, like any other organ--but feeling physically comfortable eating enough food to be able to maintain a reasonable weight. So oftentimes, that first part of treatment is we're gonna work on eating more, past the point of being full. You know, this is a muscle that we're working on trying to get it back in shape. And anytime you start moving a muscle again, or moving it more, you're going to have a little bit of soreness, right? And what do you do when you have a sore muscle? You continue to get out there and play and move that muscle, right? So that's really what we're trying to do in terms of eating enough, is that we're going to have to push past fullness sometimes right to get a little bit more to get that muscle moving. And then over time, the great thing about it is it gets easier, right? So as you're eating more, it gets easier your hunger cues may improve. So you know, oftentimes the barrier, one of the biggest barriers to recovery is just that experience of fullness of saying, ‘I it's really hard to eat when I'm not hungry, right? How do I eat when I've already had, what I feel like is a good lunch?’ But we know that they need to be eating more. So I mean, I think that's something as a team, you're going to really work out with your therapist and with your dietitian, in terms of maybe working on a specific meal plan to say, ‘Okay, here's what we need to do.’ And often with ARFID, you may start with, again, some preferred foods, things that you like to eat, right? And just working on eating more of those foods to get past that fullness, and kind of work that muscle so that you get more comfortable eating enough food.

 

Dr. Karen Nelson  22:57

What might be some ways that you would work with patients to reduce some of that discomfort after eating?

 

Dr. Marcus Westerman 23:05

Honestly, the answer is it's kind of hard to. I mean, fullness is just it is an experience. There may be some coping strategies in terms of just, you know, maybe moving around a little bit, or distracting and kind of doing something different. Maybe you're watching your favorite TV show, or you talk with your family at the dinner table to kind of get through that experience. Because there's not a lot of things that we can do about fullness, other than understanding what it is, like you said, sort of naming what it is, and then working on supporting you through it.

 

Dr. Karen Nelson  23:43

So having that experience of fullness, kind of the hunger and fullness, I think about that continuum. What happens if a patient comes to you and says, ‘I don't often feel hungry, or I never feel hungry?’ How might I help them experience hunger cues? 

 

Dr. Marcus Westerman 24:01

One of a couple different ways. One is you could have a bit of that perfect storm, where you're eating less, and as you're eating less, your digestive system is slowing down and you lose those hunger cues. So for some people, just the act and the practice of a more regular eating pattern, making sure you're getting breakfast and snack and lunch and snack and dinner and dessert kind of a more structured plan. Often your hunger cues will start to kind of pop up, right? 

 

And then the other hand, there are some people that just you know, at a baseline don't really have great hunger cues. And that's okay, too. You know, I think a lot of times we will see that in ARFID that even though we're working on eating more, again, that appetite is just not particularly strong, or they don't necessarily respond to that feeling. In those circumstances, I think it is back to that idea that you know, if you ask 100 people why they're eating lunch, you know, maybe a couple will say because they're starving, but most of them will say, because it's lunchtime, right? So, then it's okay to just say, you know, ‘It is breakfast. That's what we do when we get up in the morning, is we have something to eat, we have a snack during the day, we have dinner every day, we have a dessert at night.’ So sometimes it's just a question of, of practicing that pattern. Just like anything, you know, you might get used to going to school, you get used to go into work, that's just something that you do. You may also kind of push against some of those low appetite cues by just knowing what you need to eat and when you need to eat.

 

Dr. Karen Nelson  25:38

So it sounds like there are some aspects of treatment that we have talked about might be uncomfortable, might be challenging. I think what also sounds hopeful, is potentially another part of healing is to increase enjoyment around eating. I mean, can that absolutely a component of treatment?

 

Dr. Marcus Westerman 25:59

Yep, absolutely. And I think we see that as both—one, you're discovering those new foods that may be some of your favorite foods, you just haven't tried them yet. And two, as you're eating more regularly and more consistently, and have a pattern of expanding your diet a little bit more comfortably, again, the enjoyment of food, discovering new things, but also getting some of those kinds of biological cues back, that often happens. So yeah, I think that's what's so fun about treatment is not just that you're working on overcoming a difficulty that you're having, but you're actually learning something that can be, really enjoyable.

 

Dr. Karen Nelson  26:46

As we talk about recovery from ARFID, recovery is possible, and what might recovery look like?

 

Dr. Marcus Westerman 26:54

The way I explained it to patients and families is-- again, we’re not talking about making you a Top Chef judge or a foodie, or anything along those lines. Really, the goal is to feel more comfortable, and know that you're capable of expanding what's going on with your eating, be it expanding the variety, be it eating more consistently and regularly, or, again, challenging some of those fears that you might have with food. And knowing that with practice and support, those things can get better. And you can feel better, both physically in terms of what we help with in terms of weight restoration, but also mentally and emotionally.

 

Dr. Karen Nelson  27:41

Well, let's transition and talk a little bit about as friends and family may be listening to this and hearing us talk about the experience of someone who is struggling with ARFID, what is the best way to support someone who has extreme picky eating, and that you a suspect, may be struggling with ARFID?

 

Dr. Marcus Westerman 28:03

In terms of supporting with family and friends, I think, one, recognizing, ‘Hey, this is the thing, this is something that people struggle with. And this is something that we can get help for.’ And just having that conversation and listening to the fears. If the fear is, ‘They're gonna make me things that I don't like. Or just leave me alone, I'm fine.’ You know, I think those kinds of things are common to hear of, particularly with kids and adolescents. And just recognizing and naming it and saying, ‘Yeah, I really see that this is a problem. I think maybe we could seek some help. And maybe if we're just going to talk to somebody about it.’

 

Dr. Karen Nelson  28:45

I love that you bring that up about starting the conversation. We talk about that literally on every episode that we've had, about sometimes the lack of conversation or lack of discussion can make it even more intense. And so having the space of just saying, ‘Gosh, I'm noticing this’ or ‘I'm seeing you struggle. Is this a thing?’ and reaching out for more information.

 

Dr. Marcus Westerman 29:11

I often talk, when I when I talk with primary care doctors or pediatricians, I stress to them that you know, if you're noticing a problem and not talking about it, then the assumption is that it's not a problem. The patient or the parent will say, ‘Well, you know, I just went to the doctor and they didn't say anything, so it must be okay.’ So I think it is really important. And I stress that to physicians that, if you are worried about their growth or you are worried about weight loss, to have that conversation, ‘Hey, I noticed that this is happening. Are there you know, things going on with your eating that we could talk about or their worries or fears that you have? And maybe we can talk about ways of getting some help.’

 

Dr. Karen Nelson  30:00

Absolutely. One of the things I actually do a lot in session is I'll literally say the words, ‘I'm going to notice something out loud. And I'd love to hear your feedback.’ And just like creating the space, and you know, our patients do a really beautiful job of saying, ‘Yep, that part fits that part doesn't.’

 

Dr. Marcus Westerman 30:17

And I think that's a great way, you know, to start things off by just saying, you know, ‘I've noticed this.’ There's no judgment, there's no assessment of things. It's just saying that there might be something that you're concerned about, is that something you're concerned about also? And most of the time, again, once you get over that barrier, then all of these things will come out, because again, it tends to kind of hide in the shadows, because there tends to be that worry about something being wrong.

 

Dr. Karen Nelson  30:53

I love that. Well, I was chatting with someone recently, we were talking about the importance of supportive pushing. Like, you know, it's part of my job to encourage and ask questions to help you be curious. And to do experiments, right. We use that word, a lot of like, ‘Let's try this out.’

 

Dr. Marcus Westerman 31:11

Yeah. And honestly, that's a big part of, you know, ARFID treatment, it really is kind of a big experiment. You're, you're trying new things and kind of moving towards something that again, initially will feel a little bit uncomfortable. But that's okay. Because comfort is overrated, right? Nothing you ever do in life that's going to be at all fun, or interesting or exciting is going to be totally comfortable.

 

Dr. Karen Nelson  31:39

Absolutely. Well, I think sometimes it's a misperception that discomfort has to equal bad or I need to stop it. Right? It's through that discomfort that we grow. And I love that, sometimes even just naming that and identifying like, ‘Hey, this is gonna feel a little uncomfortable. And then we know you're doing it right.’ Is there anything that I haven't asked you that you'd like to say?

 

Dr. Marcus Westerman 32:06

My takeaway, really, for patients and family is really knowing that this is a diagnosis. Knowing that these are things that people struggle with. It's not even necessarily an uncommon thing. There's a lot of people out there that have similar struggles. And also just to know that we do have treatment, we have very specific treatment for this. And that recovery is really possible, making change and moving forward through some of those fears to a place where you can really enjoy the things that go along with food and life.

 

Dr. Karen Nelson  32:43

Well, thank you so much for joining me today. I've really enjoyed our discussion.

 

Dr. Marcus Westerman 32:47

Me too. This has been amazing.

 

Dr. Karen Nelson  32:51

That's it for today. Thanks for joining me. We've covered a lot, so I encourage you to let it settle and filter in. And as I tell my patients, at the end of every session: Take notice. Pay attention. And we'll take it as it comes. I'll talk to you next time. Melrose heals a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation.