On this episode, Dr. Karen Nelson is joined by Greg Fedio, Clinical Project Manager at HealthPartners to discuss the impact of eating disorders amongst the LGTBQ+ community.
On this episode, Dr. Karen Nelson is joined by Greg Fedio, Clinical Project Manager at HealthPartners to discuss the impact of eating disorders amongst the LGTBQ+ community.
For a transcript of this episode click here.
Dr. Karen Nelson 00:01
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.
Dr. Karen Nelson 00:12
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 Greg Fedio, clinical project manager at Health Partners, Greg and I will discuss how eating disorders impact the LGBTQ plus community. This, of course, is a very broad topic. Our goal with this episode is to begin the conversation so we can better support those within the LGBTQ plus community and their eating disorder recovery.
Dr. Karen Nelson 00:53
Now, before I begin, I invite you to take a deep breath, and join me in this space. Greg, welcome to the podcast. I'm so excited to have you here with me today.
Greg Fedio 01:03
Thanks. I'm excited to be here. Well, I would love it. If before we get started, you could take a moment and introduce yourself. My name is Greg Fedio, use he/him pronouns. I'm a clinical Project Manager for HealthPartners, I've been with the organization for 22 years, I got my start, actually at Melrose, I was there from 2000 to 2010, a registered dietician by schooling and help coordinate the day program and a whole bunch of different things. And so it's nice to get back to my roots and have this conversation with you. So excited.
Dr. Karen Nelson 01:42 So lucky for us is you know, this depth and wealth of experience that you bring. And one of the areas that we're going to be focusing on today, you've actually done a lot of work at Park Nicollet, regarding awareness and training around sexual orientation and gender identity. And I would love it if we could maybe talk about that a little bit.
Greg Fedio 02:02 So in my role as a as a clinical project manager, I lead to a lot of, you know, organizational work around like So take, for example, colorectal cancer screening. So the Minnesota Community measures and national measurement groups set certain parameters around populations that need to be screened for colorectal cancer. And so my job is to work with our teams to make sure they have the right tools and processes around meeting those metrics. And through that work, we are very focused at our organization on closing disparity gaps and are in health equity. So especially around screening gaps between white patients and patients of color. So I've gotten a lot involved in a lot of our work around equity through my existing role.
And then I identify as a as a gay male, and openly out at work and happy about it, I people know that and it's amazing to be able to work for an organization that that that lets me be out and happy about it right and be able to talk about my life. When the organization started working more with the Health Equity cabinet and our cornerstones around anti racism and improving health equity. One of the one of the focus areas was improving health equity for LGBTQ plus patients and members. And as my experience as a project manager. And you know, even though there's not necessarily quality metrics we're looking at for this population. I was tapped to help lead and shepherd some of the work of the organization around LGBTQ plus health equity.
Dr. Karen Nelson 03:50 I mean, just fascinating, right, this kind of attention to inclusion, right. And health equity, I think just feels so important. I would love to know, Greg, I mean, just my curiosity is just popping all over, you know, in in some of your tenure in this position. Have you seen change?
Greg Fedio 04:07 Oh, my gosh, yes. But there have definitely been changes, you know, at the organization to I think the leadership and it's really a top down approach really, like the leadership of our organization has really, I don't want to say bought into it, but really led the way in terms of saying hey, this is what we're doing. This is part of our core values, you know, this health equity piece, no matter which population you're looking at, and there's so many diverse populations that we're working on improving health equity for, but you know, it's nice to know again that we work for an organization that that it is that LGBTQ plus specific health equity is a focus area like you know, this is one of the you know, one of the areas that that the organization is taking serious. So the other things that and some of it is part of the work of our group that I'm thrilled to help lead. We're doing a lot with our electronic medical record to make sure that we have the right information in our charts for our patients. So number one that our staff know how our patients want to be addressed. So specifically with pronouns, making sure that pronouns can be documented in our chart, and clearly visible. So when you pull up a patient's chart, it's right there. You don't even have to dig for it. If they have told us what their pronouns are, and they're documented. We're also doing a lot of work with preferred name, where, you know, it's not, I think, in the past, our mindset has always been very legalese. Like you have to address, you know, when you're calling the patient, you have to say, “Gregory”, you know, instead of Greg and, obviously, certain documents and letters we have to have legal name on. But we're really trying to take steps towards making sure we're using preferred names. So even when you pull up a patient's chart that you see that more clearly than been the legal name. You know, a lot of our even our documents where legal name is required, we're also including preferred name. So big steps. Yeah. So really, the stuff that we're working on? Absolutely.
Dr. Karen Nelson 0:6:05 Today, we're going to be focusing our attention on eating disorders and how they impact people in the LGBTQ plus community. And we want to just make a note and just identify that, you know, this topic is very broad. And so today, we may just be kind of skimming a little bit on the top and may not have the ability to completely dive in deep into all of the nuanced areas, but really want to just start this conversation and how lucky we are that you're here with us today to just explore and help us learn. So I would love it. If maybe we could start with: what does though that acronym LGBTQ plus stands for?
Greg Fedio 07:07 Yeah, and I think it's really important to define this because within the LGBTQ plus community, there are so many different groups, right. And I think, overall, we have a tendency to lump people together to compartmentalize to try to explain things in our in the terms that make sense to us, when it might not make sense to even the community that we're we're talking about. So, it is important to define it. So “L” is for lesbian. So women that are attracted to romantically or physically to other women, G gay, usually men that are attracted to other men, but sometimes gay can be used for the whole community. And sometimes women will identify as gay to or say that “B” is bisexual. So when we look at things and um, binary, so bisexual, we would be people that are attracted to both male and females, you know, there's more terms that we might get into later, like pansexual, that is more inclusive of more than just the binary, the “T” is transgender. So transgender are people that that their gender identity doesn't align with how, what their sex assigned at birth was. So for instance, if my sex assigned at birth was male, and my gender identity is female, I can consider myself transgender. I am cisgender, which means same or, or, you know, so I was assigned male at birth, I identify as a male. I am cisgender. And I think it's also important to to note that that so when I was talking about that lumping or that compartmentalizing before, transgender is more of a gender identity, whereas that LGB that lesbian, gay, bisexual are more sexual orientations, right? So there's, it's really important to denote the difference between sexual orientation and gender identity, they are not the same thing. And I think that's also very important for me to call out to I don't identify as transgender. So when I might be talking today about some of the, you know, the eating disorders in the transgender community, I can't speak for that community completely. And then “Q” could stand for questioning people that are identifying, still working on who they are. I mean, that's all of us. I think we all are questioning a lot of things at all times. But also queer. And queer is a very pointed word, I'll say, queer is a word that has been used in the past as a slur. So there are a lot of people in the community that still really struggle with that word and don't want to use it. I embrace the word queer. I think it's just a great catch all term for our community and for the way I kind of feel and how I identify it's just not just queer. And, but but it's also one of those words.
You should never identify someone else as queer unless they tell you that's how they identifies. It's kind of our word right? So I you know, and people name themselves people tell you who they are, you can't tell someone else who they are. So and then the “Plus” think the plus is just because our vernacular, and our terminology is expanding all the time. So there's always new terminology coming in. And I just think it can't be. It can't, we can't has a definition, keep expanding it. So that plus is added on is just saying, hey, there's a lot more to this community.
Dr. Karen Nelson 10:21 I love it. Again, just a beautiful description, and really just helping our listeners, maybe learn a few things. Again, I think sometimes when there is fear, or uncertainty, sometimes our tendency is to hide and to not talk about it or not ask questions for fear of being, you know, what if someone thinks I'm, you know, I'm not smart? Or how could I not know these terms? We can't know unless we know them. So asking questions in a really safe space. That's absolutely what we want this podcast to be. And so I just deeply appreciate you taking us through and helping us learn. It's super important. Greg, as we focus our attention on this intersection of eating disorders and how they impact people in the LGBTQ plus community, let's maybe focus our attention there. What do you think, potentially may be some misconceptions that people have regarding eating disorders and people who identify with the LGBTQ plus community?
Greg Fedio 11:40 Oh, that's a really good question, misconceptions, I think you first have to be aware of what the conceptions are. Right. So, you know, the data seems, or the research does seem to suggest that there is something about trauma or underlying trauma, I think just with it is with other people developing eating disorders, more so in this community. That might be a potential cause. So I think that, you know, when we're talking about the conceptions, and I think that that stands to reason, right, so somebody is struggling with their identity of who they are, whether whether it's a gender identity, or sexual orientation, people are trying to figure out who they are. There is the stigma, there is the bullying, there is potential sexual or physical abuse. So it almost a hate saying it, but it almost stands to reason that people in the LGBTQ plus community are, are more likely to get an eating disorder, because the underlying, I don't want to, well, sometimes there's trauma, but but the underlying anxiety and stress of being LGBTQ plus are already causes of eating disorders. So if you have both of those things together, unfortunately, it is it is kind of, you know, a path to an eating disorder, rather than protective.
Dr. Karen Nelson 13:10 I love that, I think, to just name and identify the kind of the function of eating disorder behavior, what I know, for sure, and I say to my clients all the time, I don't know a lot, but I've, I've learned a few things. And I know this, that eating disorders show up in an attempt to manage numb out or distract from really intense emotion. And so what I hear you so beautifully describing, Greg is just the intersection of how someone from the LGBTQ plus community may experience unique stressors or trauma, discrimination, you know, in intense emotion, it makes sense that I may be susceptible to engaging with this behavior to try and manage those emotions to set connect or?
Greg Fedio 14:01 100% 100%. You know, like, I might not be able to control all of this, but I can control that, you know, that especially when it's about your identity, right, and who you are. So again, yes, everything you said really hit a chord for me. It really is about that numbing about that, that that? Trying to control something when I can't control anything else. But there is that, this identity piece too, right? You think about and again, as I said earlier, I am not I don't identify as a member of the transgender community. I but when you think about not being necessarily or you think about gender dysphoria, or that that concept of the incongruence between what my sex assigned at birth and how I see myself there that already is uh, you know, a situation where I'm not comfortable in my own skin. So, you know, the pervasiveness of that eating disorder, thought process, again, it's like hand in hand like it's going to attach to that too, right. So not only am I not comfortable at this part of myself, but you know what, you're not comfortable about this part of yourself either. And so it is that pervasiveness of the actual, you know, eating disorder that I think can latch on to that. And we do see it, and we do see it in the statistics, really, you know, members of the transgender community and in particular, do have elevated rates of eating disorders.
Dr. Karen Nelson 15:40 Very good point, when I think you bring in, you know, naming some of that internal distress that may be happening, then living in a culture that potentially adds all this messaging and homophobia and discrimination. I mean, it feels like just a firestorm of, you know, potential risks of potentially starting to engage in eating disorder behavior.
Greg Fedio 16:07 Yeah, yeah. It's, it's, it's scary right now, I think, in particular, for our transgender youth. You know, I think so I think it's really incumbent again, on all of your listeners, any anybody that's listening, or family members, medical professionals to really keep an eye on the LGBTQ plus community right now, especially where their mental health is concerned. And to make sure that there are resources for them to ask people how they're doing, because it is scary right now for a lot of LGBTQ plus people and any marginalized person right now.
Dr. Karen Nelson 16:40 Absolutely. Absolutely. And we often talk on the podcast about the importance of naming things, checking in asking a compassionate question. I think sometimes in our desire to avoid things that are uncomfortable, we may miss opportunities to connect and direct someone to healing. And sometimes even just, you know, noticing something out loud, like, you know, I've noticed, you've been kind of down, you know, you seem to hide out in your room a lot. You know, that those can be openers of compassionate ways that we can check in with, you know, friends and family and encourage that support is there. I love how you are just beautifully identifying the the level of potential, you know, maybe, discrimination sometime overt or covert, right, loud discrimination and quiet discrimination feeling like I don't fit. Maybe hearing, you know, comments or watching behaviors. We talk about, you know, microaggressions, right. Quiet, subtle things that may happen. And if I'm living in a world that potentially sends me messages often that I don't fit, and I don't belong, and I'm not okay. It makes sense to me that there may be distress. And I'm going to figure out how to make it through. And the eating disorder is a genius, and will show up in that space.
Greg Fedio 18:40 Yep. Yep. I think it's calling out microaggressions, I think is really important, too, because we tend to focus with microaggressions on the micro part, rather than the aggression part. And micro aggression, aggression. Yes, they are aggressions right. And even if they're unintended, they are still aggressions. But again, I think the important thing is to remember the aggression piece of it. And and you're right, that I mean, it's discrimination is it's biases, and we all have bias, right. And we know that and that's, that's another important part of the health equity work is we do a lot around bias. And bias is not necessary. Bias is a thing, right? We all have them. And it's just a matter of recognizing and managing your biases. And that's the work that we try to do at organization to right is knowing what your biases are, and working on managing them so that they don't become microaggressions and true discrimination and true prejudice, right?
Dr. Karen Nelson 19:15 Those are the things that show up in therapy, because people may not understand the depth and the emotion that it creates. And the eating disorder, remember, I mean, it is in the business of trying to figure out how to manage really big overwhelming feelings. And so, again, we can appreciate sometimes the urge to engage with symptoms. Let's focus our attention a little bit broadly about adolescents within the LGBTQ plus community and the risk of potentially developing an eating disorder in adolescence. Any thoughts on that? What do you think?
Greg Fedio 20:00 Yeah, I think the most important thing about that is I'm going to take a flipside to this approach to this answer, there's a risk, obviously LGBTQ plus adolescents and children developing eating disorders, especially in the transgender community, again, because of all those things we're talking about with safety and identity and things like that. But what we also know from the research is the protective things are supportive families. And so when you're looking at like, examples of transgender families, where the parents are using the pronouns that the child wants them to use, that are allowing the child to use their chosen name, and calling the child by that those are the kids that are less likely to get eating disorders. And I think that's so important, right, when you have a supportive family. In general, we know that that's protective against eating disorders, but especially in the LGBTQ plus community, that's going to be really important. And I think so-so that's the positive spin on that, right. So when you look at the other side of that, we do see that in the statistics to youth that families have shown them that are living that are that are forced out of the house, they have a slew of mental health issues, including eating disorders and the likelihood of developing them. So I think it comes down to family, a lot of it, but when you when you start unpacking that even more, you have this whole when people are thinking about the process of coming out, like I knew my family was going to be supportive. I knew they loved me no matter what, there was no reason to think that they weren't. And yet I struggled to come out, again, as we unpack this and thinking about families being protective, and having family support, you know, almost preventing eating disorders in this population. But that fear of being able to tell my family who I know I am, is that struggle, right? So until you get to that point of coming out, you know, to your family and knowing that they're supportive, you might struggle before you get to that point to some extents.
Dr. Karen Nelson 22:20 100%. I mean, I think it's so important that you bring up the I often it's one of the most frequent questions I get from family members is, number one did, is there anything that I did that potentially, you know, pushed my family member into developing an eating disorder? That's often the first question. And the second question is, what do I do? How do I help? And I think it's so important to identify the power of support, that remembering that you know, as a loved one, I don't have to be, you know, their therapist, I'm not their medical doctor, I'm not their dentist, right? Like, I wouldn't take that on. What I'm doing is I'm working to support and validate and be present, and just sit in name and acknowledge some of that emotion. It's probably the hardest, deepest work we'll ever do as humans, is to sit with uncomfortable emotions with somebody else. It's the it's the, it's the magic of therapy. Right? I want to pretend like I'm, I'm actually magic, I'm not what I'm really good at, is sitting in a room with someone in their deepest pain, in their most intense fear, and holding it. And family can do that all the time. But there has to be a willingness to do it. And I love it, that you named Greg, even though I know my family is supportive. Sometimes I don't know until I start to have that conversation. And it's almost demonstrated.
Greg Fedio 23:56 Oh, my gosh, you're 100% on with everything you're saying. And it's interesting, you're bringing up this concept of holding, because we're doing a lot of work with that right now, too. And so that concept of holding, and when somebody tells you something difficult to, to embrace that discomfort, and to let them hold it, but to hold it with them is so important. And it isn't necessarily about fixing.
Dr. Karen Nelson 24:21 Are people who identify as LGBTQ plus, are they more at risk, Greg for potentially developing any issues with anxiety or depression or other general mental health issues?
Greg Fedio 24:35 Yeah, definitely, definitely the LGBTQ plus community. I mean, it's well documented in the research experiences, mental health issues at a higher rate, I would say than, than the general population. So, you know, definitely documented things of increased risk of self injurious behavior and especially suicidality. The suicidal thoughts, and then follow through on suicide. It's estimated right now that the average life expectancy of a black trans woman in the United States is under 35 or so between 30 and 35 years of age. And that is a sobering statistic. Right. And some of that, most of that, I would say, is mental health issues. Right. So whether it be suicide, contributing to that lower age, drug use is rampant in the LGBTQ plus community as well. And then violence, as well can contribute to that. And all three of those things, you know, obviously, our impact people's mental health?
Dr. Karen Nelson 25:45 Absolutely, absolutely. I was reading a paper what they were talking about 42% of homeless youth are actually they actually identify as LGBTQ plus, and you know, often people in you know, adolescence within that community within the LGBTQ plus community are more at risk for being bullied for weight or shape or size. And so just these intense experiences that these adolescents and adults are having, as we were talking that can increase the likelihood of potential risk for developing eating disorder behaviors.
Greg Fedio 26:25 Yeah, that homelessness space is another is another sobering statistic. Right. And but it also comes back to that family piece, where we were talking about how family is, is protective. And a lot of these things, and having a supportive family is really crucial. You know, even if a patient if somebody does develop an eating disorder, having a supportive family is crucial to helping them through it. Right. But if you don't have a family at all, especially one that's not supportive enough to not give you a place to live. Yeah, things start spiraling. Right. And again, I think we keep coming back to this too, but like the concept of identity, and affirming who you know, you are, when it might be not what everybody else wants, or expects, is really difficult and a breeding ground for mental health issues.
Dr. Karen Nelson 27:07 Let's focus our attention a little bit on treatment and recovery. So what factors may prevent people who identify as LGBTQ plus from seeking treatment? Are there potential factors that may prevent them from accessing treatment?
Greg Fedio 27:38 Yeah, I think this is for all populations, right? Just the fear. Right? The, the fear of you know that that constant eating disorder message of, you know, I'm the only thing you need, right? Please, please stick with me and don't try to get rid of me. So I think fear, but again, that's more inclusive of all people, I think it comes down to trust for a lot of marginalized communities, right, there's a reason for mistrust with health care professionals. Again, and we talked about this a little bit promoting your healthcare organization, or facility or whatever you might be working in setting you might be working in as a safe space, you know, putting up a rainbow flag on your doors. And again, I'm talking to people that might be, you know, have their own private practices or things like that, or stores or anything like that. You know, I think that symbolism is very important to our community. You know, to see I feel safe walking into this space and knowing that I'm okay to be who I know I am.
Dr. Karen Nelson 28:46 Do you think there are any specific factors that can increase the likelihood that someone you know, in the LGBTQ plus community may be accessing treatment?
Greg Fedio 28:55 I think the most important thing is like, if I call to become a patient at an organization, if I put myself out there enough. And I again, I'm trying to think of somebody like, that may be transgender that might have a chosen name that's different than their legal name, right. And that happens for a whole bunch of different reasons where, like, people just haven't changed their legal name, and they don't have to right this is what my name is, according to me, and this is what I tell you, I want to be called, then you should call me that. So if I establish care, say at a place and they always keep coming back to calling me by my legal name, or I tell them that my pronouns are they them, and every time somebody says she, you know, everybody, you know, then there's a reason for not continuing to invest in that business or organization, because they're not investing in me, right? They're not showing me the respect and dignity that I deserve. And so I think it is about that constant learning and that constant improving. But in general, I think just in general in in society, you know, taking the time to learn a person's story, and validating it. And you know, again, we keep talking today about you, if somebody tells you who they are you believe them, like, you know, that's what we want for ourselves and that and that's what we should be doing for everybody. Right? So you can't say no, no, no, you're not that. No, yes. That's what you said, you are. Okay. That's who you are. And I think people have a tendency to gravitate towards those places that demonstrate that investment in them?
Dr. Karen Nelson 30:43 Absolutely. I think the main thing, which is so clear, is how about I don't tell someone else who they are, right? Like, it's just so we could have a whole podcast on that,
Greg Fedio 30:55 When you think it's basic, right? But then you start thinking about it. It's like, it's not basic. For some people, it really isn't. It's like, No, this is how I see you. So this is who you are.
Dr. Karen Nelson 31:07 I love that. How best can we support someone within the LGBTQ plus community who is also potentially struggling from an eating disorder?
Greg Fedio 31:19 I think this question really ties everything that we've been talking about together, you know, especially that holding piece that you were talking about, like really holding what they're what they're telling you. And so if somebody does tell you that they're struggling with an eating disorder, that's really that holding piece right to, to be able to say, I'm here with you, what do you need from me? Not trying to fix it in the way that you, you know, again, we were talking about that too, now trying to fix it in the way that you might think is best for you. But asking that person what they might need to get through the next steps. And again, I think sometimes to to think about the next steps rather than the end goal right away. If they tell you like, what are your next steps with this? What can I do to support you in that in your next steps. Because their next steps might not be getting treatment, it might not be it might just be telling you, right? So to be mindful of not jumping to fixing it for them again, but to help them on their journey. The other thing that this brings up for me too, you know, we talked a lot about, you know, embracing the discomfort as well. So to me, if you suspect somebody might have an eating disorder, and they're part of the LGBTQ community, I think that's the awareness piece, there is just being aware that, you know, again, that people in the LGBTQ plus community have, the statistics do show that there's there's a higher incidence of eating disorders and disordered eating behavior. So to be aware of that, so that if you do suspect to somebody, to maybe have an uncomfortable conversation, at some point, we know eating disorders and 100%, this has not changed since the time I left Melrose, right, that eating disorders, embrace that hiding spot, that shame that like, keep it quiet, nobody knows this is going on. And we know that when people know that that person is struggling with an eating disorder, but don't say anything. It just feeds the eating disorder, right. It's just like, I'm getting away with this, I can keep doing this. So if you suspect having a friend in the LGBTQ community that might be struggling with an eating disorder, arm yourself with the proper ways to have that conversation with them about and that uncomfortable conversation. And I think that's a topic for a different podcast is really, you know, like, how do you approach somebody that you respect and admire people and respective manner. But I think that's where it comes back to embracing that discomfort and being able to say, Hey, these are the things that I've seen, you know, arm yourself with this, your facts.
This is this is what I what I'm seeing, and how are you feeling? You know, and again, you're starting that conversation to be able to hold what they tell you they're feeling. But yeah, so and I think then, that expands it into all of these other conversations around LGBTQ plus health equity and further health equity, you know, being able to disparate the to embrace the discomfort in some of these conversations.
Dr. Karen Nelson 34:33 Absolutely. Well, Greg, I cannot thank you enough, that conversation is just literally so great. I just appreciate you in all of your wisdom and knowledge and just helping all of us grow. It's been a joy.
Greg Fedio 34:57
Thanks. This has been super fun, and I'm really happy that I was able to participate.
Dr. Karen Nelson 35:00 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.
Dr. Karen Nelson 35:16
Melrose heels a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation.