Melrose Heals: A conversation about eating disorders

Episode 38 - Fueling for Sports

Episode Summary

On today’s episode, we will be discussing food as fuel for our bodies. Dr. Karen Nelson is joined by Jillian Tholen, a registered dietitian at TRIA who will help us understand what it means to balance nutritional needs and exercise as well as how disordered eating can impact athletes.

Episode Notes

On today’s episode, we will be discussing food as fuel for our bodies. Dr. Karen Nelson is joined by Jillian Tholen, a registered dietitian at TRIA who will help us understand what it means to balance nutritional needs and exercise as well as how disordered eating can impact athletes.

For a transcript of this episode click here.

Episode Transcription

Dr. Karen Nelson: [00:00:00] Eating disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that we'll 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, we'll be discussing food as fuel for our bodies. When we increase activity, we also need to eat to support it. I'm joined by Jillian Tholen, Registered Dietitian at TRIA, who will help us understand what it means to balance nutritional needs and exercise, as well as how disordered eating can impact athletes. Now, before I begin, I invite you to take a deep breath and join me in this space. [00:01:00]

Welcome to the podcast, Jillian, I'm so happy to have you here with me today. 

Jillian Tholen: Thank you. Thanks for having me. 

Dr. Karen Nelson: Before we get started, I would love it if you could introduce yourself and tell us about your role as a dietitian.

Jillian Tholen: Sure. My name is Jillian Tholen. I am a registered dietitian who specializes in sports dietetics and also in eating disorders. And I work at TRIA, which is an orthopedic center. And I'm also a part of the women's sports medicine program at TRIA. 

Dr. Karen Nelson: That's awesome. And so just to clarify, TRIA is actually a part of Health Partners and they specialize in orthopedic care and sports medicine. And you are a dietitian embedded into TRIA. 

Jillian Tholen: Yeah. Correct. We are a group that specializes in caring for women, in particular active women. And we tend to collaborate and talk about the different patients that we serve and try to come at [00:02:00] our patients from all angles. And that's actually the reason I was brought on at TRIA. Because they started this program and really wanted to be comprehensive with care for female athletes and recognizing that nutrition can be a big part of just being an active woman. And when we're seeing, you know, active women who are struggling with injuries, there's often more than one factor. So we have the physical therapist, we have the MDs, the surgeons, and then I'm also part of the team too. So it's really neat to be on a team like that, because nutrition isn't always something that comes up as a first thought of like, ‘Well, we have a bone stress injury, we have a stress fracture here, we're gonna stop activity, we're gonna go to physical therapy. What else can we do to prevent this from happening in the future?’ And that's kind of where I get to be involved, which is great. 

Dr. Karen Nelson: So exciting. Yeah, it sounds really exciting, this kind of aspect of collaborative care. And that's absolutely what we're going to be talking about [00:03:00] today, and accessing your specialized knowledge of that intersection between athletics and sports, and the importance of having some conversations about food.

Jillian Tholen: I think there's so much intersection, all of the things that our body can do for us. And all the energy those functions require, just even when we're sitting here, right? It takes a lot of energy just to run the human body. So when we add activity on top of that, it can be an incredible amount of energy in addition to what we already need. And so with sport in particular, one of the ways that I like to talk about nutrition is, if sport requires training, for example, the way we get better at our sport, the way we gain fitness, the way we gain strength is not actually when we're doing the sport, it's actually when we're recovering. That's how our bodies become better at what they're doing, they become adapted, and we absolutely can't do that without nutrition. I mean, our bodies are pretty resilient and they can do a lot, but really, I try to frame nutrition as a part of [00:04:00] training because that's really what enables us to recover, come back, gain that strength, that fitness, repair, adapt, and then be ready to go the next day. And we also know that nutrition supports the rest of our physiology as well.

Dr. Karen Nelson: Absolutely. I think you're bringing up so many wonderful points that we'll explore. Just kind of wondering, were you a sporty kid growing up? I was not, so I will name that. Tell me about you. 

Jillian Tholen: Yeah, I think it definitely comes from a place of personal interest. I actually would say that a lot of why I do what I do and why I love what I do is because I wish I would have known what I know now when I was a high school athlete. I wish I would have had the guidance that I hope I can provide to my patients and clients. And my dad was really into running and so as his first child was thinking that would be a fun way for us to be active and that would be a fun thing to [00:05:00] share with me. So I was running road races when I was like in like fourth grade, I remember doing that. And it was very casual. But then when I was in high school, I started running. So I ran cross country and track in high school and also played basketball. I went to a really tiny high school. And so it was pretty typical to be a three sport athlete that didn't specialize. And I'm really grateful for that experience now. But yeah, I was definitely into sports. It was a huge part of my life. I ran in college as well. So I was pretty serious about it for many, many years as a scholarship athlete. And again, there were so many things I didn't know about nutrition, about training, about my body, about the mindset, you know, just mental health as an athlete that I wish I would have known. But at the same time, I think it gives me a lot of foundation and empathy, even for people who I work with now. Especially younger folks, but you know, of all ages. 

Dr. Karen Nelson: Absolutely. Were there any kind of highlights that, ‘Gosh, I really could have used this information as a teen athlete or a college athlete.’ What kind of bubbles up when we think [00:06:00] about that?

Jillian Tholen: Yeah, I think the first and the biggest one in my experience was, I wish I would have known about the importance of my period and seeing that as a vital sign and a sign of health or a sign that something was off. And I like this is something I talk with so many athletes about and want parents and coaches to know and to be comfortable talking about as well. I didn't have my period for many years. And again, I wish I would have known that I for sure missed out on a lot of bone development that I now will never have the chance to have. But I just didn't know. No one told me that was something that I should be watching out for or be tracking. Just didn't know what I didn't know. And so that's probably the biggest one. And that's something that I get to talk about a lot in my work. One of the things I try to help my active patients – and especially active women understand is that, as athletes and as humans, whether we're male or female, we should be impressive eaters. I didn't know what healthy eating meant [00:07:00] and I wish I would have known that. That's another word that is confusing. Like if people are going to make comments on our food, which we wish they wouldn't, but if they are, maybe it's going to be something like, ‘Wow, you're eating – you can really eat a lot.’ Right? Like we should be impressive eaters. We should be eating a lot of food. 

Dr. Karen Nelson: I want to kind of pause around that comment that you made about the seriousness of an athlete losing their period. A couple episodes ago, we did an episode with one of our medical doctors, Dr. Kardell, and she talked about the seriousness of when a female is losing their period, there's a lot of implications to that. And like you said, if I just don't know it's a big deal, I may minimize it and it's not until I get the education through care providers that I might realize, ‘Oh, something is happening in my body that it is no longer producing that kind of natural menstrual cycle.’ And it sounds like as an athlete yourself growing up, that maybe wasn't [00:08:00] talked about or maybe it was even normalized that I might lose a period. 

Jillian Tholen: Yeah, I think, in my experience, it was never talked about. I have heard accounts of it being normalized. Which, I mean, neither is great. That could be particularly harmful, I think. I was a runner, so I have a really specific experience in that sport. I know it happens in other sports. But when coaches are saying things like, Oh, well, you're training hard enough if you lose your period. That those kinds of messages can be extremely harmful for young athletes and create really, toxic messaging and just relationships with food and body and the cues from our body and a lot of confusion really, too. So I try to be pretty vocal about ‘This is what we know. This is what's true: It's absolutely never okay to miss your period. It doesn't mean you're doing a great job training. It just is telling us there's actually something wrong.’ So obviously trying to be gentle with my language [00:09:00] but also pretty direct that there is absolutely no case in which it is normal for a female or female athlete to skip a period.

Dr. Karen Nelson: As we're talking more about your unique connection with being a dietitian for athletes and people who potentially may be considered a professional athlete or we'll call them kind of weekend athletes – people who are just really active. Let's maybe explore, what might be a place that I start that conversation? Or what have you noticed with your patients?

Jillian Tholen: I'm always looking for things like, what is your activity level? If it's someone who is active and who is an athlete, I want to know about their training. I want to know how many hours a week they're spending training, what kind of intensity. Are they working with a coach or a team? Do they have guidance? Are they kind of deciding what they're doing on their own? What their history is around that. I'm also always really interested in learning about not only what food looks like for them now, as they're sitting in my office in this moment, but also what their relationship has been with food [00:10:00] since they've been little, throughout through their life. And that can be sometimes really helpful to understand because everyone is in a different spot. If I'm seeing someone who's a high school athlete who's purely just interested in learning more about sports nutrition, that's going to be different than maybe someone who is in their 30s and is dealing with their second stress fracture in the last two years or something like that, right? So, I'm always looking for history, for that kind of information. And then we'll get into, you know, the day-to-day of how many meals are you eating a day? Are you skipping meals? Do you eat snacks? Are there foods that you avoid? How's your digestive system? Just talking about things like that as well. So, for example, if someone's coming to me and they're saying, I typically eat two meals and two snacks a day, and I never eat breakfast. I typically don't eat until noon, I like to work out in the morning. Right away, to me, I'm noticing, okay, we have a big gap at the beginning of the day. And if we need a lot of energy to meet our [00:11:00] needs during the day, and we're missing out on an entire meal that should contain all of our nutritional components, right, we're gonna be behind. There's no way we're gonna be getting enough energy or nutrition. So, things like that. If we're going long periods of time without food, that can be stressful for our bodies. And if we are needing more, especially again, if we're active, I would say it's pretty rare-to-not-possible for an athlete to only eat meals and not have snacks and meet their needs. So I'm kind of looking for those things at first. And then, you know, within meals and snacks that someone might be telling me that they're eating, I'm also assessing for, are we including all food groups? So those are all things that would then come up in conversation that help my patient get curious. 

Dr. Karen Nelson: What might you notice, Jillian, as a dietitian about assumptions people might make as far as how they're supposed to fuel their body due to their, you know, pursuing a particular athletic goal. Do you think there's assumptions that people make? 

Jillian Tholen: That's a really good question. [00:12:00] I think it can depend on the sport sometimes. The mainstream diet culture is something that all athletes are still hearing and immersed in, and so one thing I notice is that whatever the diet is that's kind of most popular in the world tends to show up as well with athletes who are coming to me. And so, you know carbohydrates, for example are extremely important for all humans and for athletes in particular. When we're adding more activity, we have to increase carbohydrates. Our bodies use them for our main source of energy, and you know I could go on and on. 

Dr. Karen Nelson: Wait. Did you just say carbs aren't bad, Jillian? Right? 

Jillian Tholen: Carbs are life. Oh my goodness. 

Dr. Karen Nelson: Carbs are life. Make a bumper sticker. Someone please. 

Jillian Tholen: Really. I could talk about carbs all day. The idea that carbs are scary or I shouldn't have too many carbs or athletes just not eating enough of them because they're worried about, ‘Well, carbs are going to, you know, do this, this, or this, or they're unhealthy [00:13:00] for me, or I heard that I shouldn't have sugar.’ So there's a lot of assumptions about carbohydrates and whether they're healthy, quote unquote, or not. It's something that comes up in the general population, and I certainly see that in athletes, despite the fact that athletes actually need more carbs even than the rest of us.

Dr. Karen Nelson: Is there, like, an optimal amount of either types of foods or certain foods that an athlete should be eating? Or, help us know about that a little bit. 

Jillian Tholen: So I'm not a dietitian who likes to rely on numbers in really any case. There are some very specific situations in which I would throw out X grams of this as a goal per meal or per day. But it's not super common. That has more to do with like in race fueling or during like long run training or like endurance training or maybe timing before or after exercise. I try to kind of marry the principles of sports nutrition with also allowing our bodies to be intuitive and, you know, [00:14:00]really listen to our cues. So, for that reason alone, I really try to avoid numbers. 

Dr. Karen Nelson: So perfect. Do you ever notice patients talking about hunger and fullness or, ‘Well, I don't really feel hungry in the morning, Jillian, and I don't want to eat if I'm not hungry.’ How might you respond to that? 

Jillian Tholen: Yes. I'm so glad you asked this question because this is one that can be really interesting to explore, especially in the context of sports nutrition. We love to think that Eating is as easy as, I eat when I'm hungry, and then I stop when I'm full. But there's a lot more nuance to it than that. We have to kind of combine it with our knowledge. And so one thing that we'll commonly hear – the morning one, does come up for people. Especially if someone has not been a breakfast eater in the past, or maybe they don't often eat that meal. I will very frequently hear, well, ‘I'm not hungry in the morning, so why would I eat?’ So then, we can come at that with some reasoning. Some science, some education about why it's important for our body to get food, you know, [00:15:00] probably within the hour of waking up. So we can talk about it in terms of our physiology. And we can also talk about that in terms of, our bodies can get used to that. And sometimes I can use analogies that are helpful for sport as well. Something like we're training our stomach, just like we would train any other muscle, to expect food or to want food. So that's something I hear with the morning frequently. Another one that comes up often for athletes is actually eating in and around activity. So it's very common, and there's good research even to support that our appetite is blunted after exercise, especially more intense exercise. That's one of those situations where I love to talk about it because there's so much great research and reasoning for eating in that window: The 30 to 45 minutes after exercise, and we can talk about why it's important to prioritize carbohydrates, for example. But really the why feels important to me, because I guess I'm someone who really likes to know why, especially if feeling like it's in exact opposition to what my body's telling me. I'm going to want to know why then [00:16:00] I should be doing that. If I'm trying to be intuitive, if I'm trying to listen to my body, why would I eat when I'm not hungry? So that's a great example of something that frequently comes up. 

Dr. Karen Nelson: Love it. Jillian, I'd like it if we could maybe talk a little bit about weight and BMI with athletes. And I'd love to hear your perspective of, what have you noticed with athletes coming to you? Are they wanting to talk about weight? You know, do we ever get concerned about those numbers? How might we use BMI to inform our discussions? I'd love to hear your thoughts on that.

Jillian Tholen: Weight is certainly something that comes up for many athletes, and again, across sports. This conversation can manifest differently for different sports, as you might imagine.

It can be particularly tricky for weight class sports: weightlifting, wrestling. That can be a really challenging discussion because these athletes are essentially forced to pay attention to their weight and sometimes manipulate their weight and it can be [00:17:00] really difficult to have a healthy relationship with food, almost impossible, when we're trying to control our weight, you know, one way or the other. So that can be really challenging, honestly, to address. And I just try to do my best to provide the education about how we fuel our bodies appropriately. I've heard athletes say this before, but there's a lot of belief in a lot of cases that a smaller body is better or, you know, fitter. People will say things like that, that’s really damaging. That can be really challenging to talk about as well. And again, I think, having been an athlete in the past, like, I do have a lot of empathy in that way. And I can also safely say that one of the messages that I will send is, the best athlete's not gonna be the smallest athlete or the most muscular athlete necessarily, if we're talking about weight or body shape or size. But the athlete who can be the most consistent and the healthiest. And leaning into what their [00:18:00] body needs. So, I try to nuance to the conversation in that way. BMI is actually not something I ever use. If it ever comes up and there are questions about it, I just like to point out that it was never meant to be a measure of health and it's not something I'm looking at when I'm assessing where somebody's weight should be. Nor am I really ever assessing where somebody's weight should be, to be honest, in these kinds of sessions. 

Dr. Karen Nelson: I think that aspect of maybe perceptions of what athletes should look like, you know, in my work as a psychologist and a lot of work with people who are either college athletes or kind of weekend athletes or those types of things, this perception of body types of athletes, right? If I'm a gymnast or if I'm a dancer, if I'm a long distance runner, if I'm a wrestler, this perception that I may look a certain way. And if my natural body type may not fall into that space, [00:19:00] then we're walking right into a pathway where I might start interacting with some eating disorder behavior to try and shift or manipulate my body. And so these conversations that you're having with patients sound really important, that you're just starting to talk about nutrition and identifying, am I eating enough to sustain the activity that I'm engaging in. 

Jillian Tholen: I really like the way that you put that, just leaning into your natural body type and trying to appreciate what it can do rather than what it looks like, feels like another important message to send to those athletes. And I think, you know, sometimes if we can reframe food in a way that it's going to help with performance and help you become the best that you can be rather than something to control or manipulate to change your body size. Sometimes that can be helpful and motivating as well, I think. 

Dr. Karen Nelson: Let's talk a little bit about this idea that we need to give our body [00:20:00] basic nutrition to just do the functions of life, right? Our heart needs to beat, our brain needs to think, right? Muscles need to move. The complexity, if I'm an athlete, it makes sense that I would need to fuel for that activity. And so tell me a little bit about that. How do you think about that as a dietitian? And then how might we have conversations with patients around that?

Jillian Tholen: I think we want to understand that when we are asking more of our bodies, we are going to need to take care of them in a different way. Or they’re going to need more energy. I like to use the word energy rather than calories, because I think that it's more of a neutral way to talk about calories, which are energy, but our culture creates a lot of negative associations with that word, and so I do try to reframe that for the people that I work with. But I think while we want to recognize that our bodies need more when we are [00:21:00] active, we also want to be really careful that we're not creating this relationship of, ‘I only get to eat more when I'm active.’ Or ‘I'm really closely kind of trying to match my activity level with my food intake.’ That's where things can get a little bit tricky. Because we just don't always know what our needs are going to be. And this is one of the reasons why I tend to shy away from numbers and equations to figure out what our bodies might be needing every day. I always say we don't know what our body is doing for us at any given moment. We might be fighting off an infection. We might have not gotten great sleep last night, and so that's affecting our metabolism. We might be recovering still from a hard workout we did two days ago, and that's really going to change our needs. And so it's trying to help, again, athletes understand that we have these principles of wanting to have structure and consistency every day with, ‘Am I eating all three meals? Am I getting all my components? Am I eating snacks? Am I eating before and after my workouts?’ But then in addition to that, if I'm [00:22:00] feeling hungrier, am I responding to that appropriately? Am I adding more to my plate? Am I going back for seconds? And how am I feeling about that? Right? Really digging into, like, how we feel about being more hungry. Is that okay? Can we respond appropriately and with gentle and kindness to our bodies rather than being judgmental or trying to have to rationalize, ‘Well, I didn't eat that yesterday, so why would I need it today?’ Or, ‘I'm still hungry after I ate this meal, but I'm done, so I can't have more.’ Right? So just really trying to also help them understand that it is okay and so important to be listening to our bodies on top of doing what we know we need to do.

Dr. Karen Nelson: That aspect of feeling like I may need to earn food or if I haven't gotten a hard enough workout, boy does that come up in therapy a lot as I'm working with patients who may be struggling with an eating disorder and also have an athletic background or may be a college athlete, this idea that I have to earn it and how risky [00:23:00] that can be. Because the eating disorder will hijack those thoughts and potentially convince us that I've never earned it, that I've never done enough activity. And so now I'm potentially restricting, I'm undernourishing myself, and it can just be a really risky pathway to go down, to say like, ‘Well, I can only have the cupcake if I do this type of workout.’

Jillian Tholen: Yes, the needing to earn your dessert or any food can be a really problematic mindset. And it's something I think I'm kind of always assessing for and noticing that in language as I'm having conversations with athletes or maybe we're talking through what eating looks like on a rest day, for example, versus what eating might look like on a day you are more active or a day you're working out. So I do try to always come back to using that intuitive piece in these conversations and then even a little education about, again, the recovery aspect. Bodies don't operate [00:24:00] on a 24 hour clock. We don't just reset at midnight, right, with our needs. We are still recovering. Our muscles are still repairing the next day, right? We might be hungrier on our days off than we are on our days we exercise. So when I can normalize that for someone and help them feel like, oh, I have permission to eat according to what my body is asking for, even on those rest days, that can be really helpful as well. One thing I like to say about rest day eating, too, is it's an opportunity for us to fill in the gaps in our nutrition. Right? Because maybe we weren't as hungry as we thought we would be, and we didn't actually meet our needs. It might not even be intentional, but maybe we didn't meet our needs on those other days where we were more active. And now here we are on a rest day and our body is just trying to catch up, you know? So it's so important to be able to lean into that intuition on those days and just, yeah, feel like, ‘Oh, I can listen to my body and that's okay.’

Dr. Karen Nelson: I think one of the [00:25:00] characteristics that is unique to someone who is struggling with an eating disorder is oftentimes a lot of rigid thinking around food. Many of our patients share with their team that they have almost like a good food, bad food list in their head. You know, saying like, ‘Brussels sprouts and carrots are okay, Karen, but never should I ever have a cupcake.’ Add then the complexity of, if I am an athlete and doing some of these high performance activities, feels like it potentially could get risky if I'm eliminating or not interacting with certain types of foods. Or, I don't know, what do you think about that? 

Jillian Tholen: Definitely. I think the word healthy comes up frequently and it's honestly, it's a word that I have a weird relationship with, I think, as a dietitian. I've kind of developed a perspective on the word that I try to use with patients when they're telling me, for example, ‘Well, I'm eating – if I don't have vegetables on my plate, it's not a healthy meal.’ Okay, interesting. Or, ‘If I have this bar with X number of [00:26:00] grams of sugar, that's not healthy for me.’ So one of the things that I like to talk about then with them is digging into, what does healthy mean to you? What have you heard about that word? And then offering, if they're open to it, how I like to think about it. And the way that I like to think about it is that healthy is contextual. What might be healthy in one moment or at one time or for one person might be completely different for someone else. So my favorite example is if you were stranded on a desert island and you didn't know when you were going to get out of there, you had the choice between a Snickers bar and some broccoli, what's the healthy choice? It's the Snickers bar, because you don't know when you're going to get food again, and that has more energy, more nutrition in it than a piece of broccoli, right? So if you're an athlete who is about to head out for a long bike ride, is the healthier choice, quote unquote, for you, some carrots or is it a Pop Tart? So we do education [00:27:00] around that as well, right? How does our body use those simple carbohydrates that we may have heard are, quote unquote, unhealthy, in that context? Like that's what we need. 

Dr. Karen Nelson: I love it. It's one of the things that we often do at Melrose also is to debunk myths around food. And it sounds like you just gently explore with them and maybe talk about past experiences with that. ‘Was I ever shamed if I ate that type of food? Was I told that I should only be eating fruits and vegetables?’ Those experiences are really impactful, and we store that information in our brain, and sometimes those thoughts can become pretty rigid and stuck. And so I love it that you're exploring with them and saying, there's other ways to think about it. 

Jillian Tholen: We love to think about flexibility and trying to encourage flexibility. 

Dr. Karen Nelson: Well, let's maybe explore further this idea, are there times where maybe in [00:28:00] competitive sports or high performance athletes, that eating may be a little bit more prescriptive, where we're saying, you need to be eating this frequently? You should be eating these types of foods. Or, or help us know about that. 

Jillian Tholen: Yeah, definitely. I use the example of the Pop Tart, which would be a form of simple, easy to break down carbohydrates. That type of food is extremely beneficial before, during, and after exercise. So those are the kinds of conversations I want to have, just to kind of, like you said, normalize, debunk this idea that I can never have that food. Well, it's actually really helpful, right, before you're going out to exercise because that's easily broken down, it gets into our bloodstream, it provides us fuel. And even more prescriptively, we talked a little bit about like before, during, and after. A good example is someone who's maybe training for a marathon and is doing weekend-long runs. Once we're running more than, you know, an hour or a little bit more than that, we actually want to think [00:29:00] about taking food with us, taking nutrition on our run with us so that we can make sure that we are doing our best to keep our bodies going when we're asking so much again of ourselves. And I'm leaning on the research and what's been done in the literature and what's been shown over and over again to not only help performance in these contexts, but also help with recovery and repair of muscles and decreasing inflammation during this really long event.

Dr. Karen Nelson: Do you think, Jillian, that, you know, prescriptive eating could ever wander into a place of restrictive eating? Or have you experienced that with people? 

Jillian Tholen: Certainly. When it becomes rigid, like you mentioned, prescriptive, I think that's where we get a little bit worried about, has this gone too far? Because I think we can be prescriptive but also still allow for flexibility. If I'm being prescriptive, likely, the language I'm going to use with my patients [00:30:00] is related to how many times a day we're eating. Are we eating this many meals, this many snacks? Are we making sure that we have these components on our plate? Maybe we have higher energy needs and we really want to make sure we have beverages at all of our meals, or beverages at snacks, things like that. But outside of that, it's not going to be like, we need to have this much necessarily, or this type of food. Getting into a place where we're feeling like we have to measure or weigh, that's something I'm keeping an eye out for. Or I can only have this type of carb and I can't have that type of carb, or this type of protein, not that type of protein. Then yes, absolutely. I think that can absolutely become restrictive, so just being mindful of that on my end is important. 

Dr. Karen Nelson: Well, and we know that being a professional athlete or a student athlete, someone who's very involved in athletics, it potentially can be a risk factor for developing eating disorder behaviors or disorder [00:31:00] type behaviors, potentially, like restriction. And so it makes sense that we're talking about that, we're noticing or paying attention to how people maybe are talking about food in session with you. I think it is important to mention, some recent data indicates that about one in three female college athletes are at a potential risk for developing an eating disorder. And so we know that this is a risk factor. And other people who have been in kind of professional athletics have come out and talked about their own struggle with disordered eating. And so having conversations about restriction, maybe about feared foods, misperceptions that I might have about certain foods that I can or should eat as an athlete. It just feels like those are really important conversations to have – of which you are having with patients. What do you notice about you are [00:32:00] potentially working with a student athlete or a teen? How might you bring up that conversation, about the appropriateness of fueling without restricting, with parents? 

Jillian Tholen: I think one important thing to just mention with parents is that they all have their own perspectives on food, and relationship with food, and history with food. And so they might be bringing certain perceptions, ideas, thoughts, judgments, beliefs to our work, or talking with our children about those things. So I try to be pretty gentle, but really just helping parents understand what to look for with their kids to help them understand if they're getting enough. Or even maybe warning signs that they might not be, or something might be affecting their relationship with their food or body. Are you seeing your child eat three meals a day? Are they eating breakfast at home before they leave? That's really important. I have a lot of discussions with not only [00:33:00] high school kids, also professionals, also grown adults about this. But that meal is non-negotiable. And we need to be prioritizing it. We need to be seeing it happen. We have to make time for it. If we have to get up earlier, I'm sorry, but I'm gonna be the one to tell you that yes, you have to get up earlier. If they're packing their lunches, what's going in their lunches, are they bringing things home? A red flag I see is when a child maybe starts all of a sudden trying to eat quote unquote healthier. Sometimes parents can be really excited about that and obviously we want our kids to be healthy. So that can be challenging because sometimes that actually is a sign that a restrictive type of eating is developing. And again, depending on the parent's perception of their child or their own beliefs about food, they might really encourage that. What I encourage again is just looking, paying attention, noticing. 

Dr. Karen Nelson: What I know about eating disorders is that they show up in an attempt to manage emotion. And [00:34:00] so as I'm listening to you talk about potential pressures that athletes might have, just this drive for excellence and performance, that has got to be a lot of emotion. And if eating disorders do anything, they can potentially help a person feel like they're coping with emotion by potentially restricting certain types of foods. And so we just start to appreciate and understand, ‘Oh, I could see how someone who may be struggling or stressed or have a lot of visibility about performance or body may start to use restriction as a way to cope with emotion.’ And so that's why, like you said, we just want to notice and be aware for any particular warning signs. I love that you bring that up. And to be able to let anyone who is struggling with some of these things know that we can work through them as well. And we can talk about, what are values, [00:35:00] what are goals, and how do those align with maybe what you're experiencing. Or what your goals might be around food or body as well. That can be really helpful when emotions come up because there's always a lot more to a story than the food.

Dr. Karen Nelson: It's so true. Well, it's actually one of our beliefs with this podcast is, when we have a little bit harder or slightly uncomfortable conversations, that's when big changes can happen. I think sometimes it's this myth of like, ‘Well, I got to keep it a secret. Don't talk about it.’ And this is my favorite. ‘It'll work itself out.’ Probably not. Like, we probably need to be talking about it to get some support and advice from a professional. So really starting that conversation as a professional in the community, we're here to just meet you where you are and partner with you. It's never about shaming or judging. 

Jillian Tholen: Whenever I have these [00:36:00] conversations, it's so kind of like revitalizing and reminds me why I do what I do and how exciting it can be. So I'm really grateful to have been able to talk about all these things that I feel are so important for people to know.

Dr. Karen Nelson: Same. 

Jillian Tholen: Wow.

Dr. Karen Nelson: It's been an absolute joy. I love this conversation. It's so applicable and important to so many. And so thank you so much for being here, Jillian.

Jillian Tholen: Thank you. 

Dr. Karen Nelson: 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. To learn more about Melrose Center, please visit MelroseHeals.com.

If you or a loved one are suffering from an eating disorder, we're here to help. Call 952 993 6200 to schedule an appointment and begin [00:37:00] the journey towards healing and recovery. We'd love to hear your feedback on our episodes, the topics we cover and anything you'd like to hear me discuss on the show. Our email addresses melrose@parknicollet.com. I look forward to hearing from you. Melrose Heals: A Conversation About Eating Disorders was made possible by generous donations to the Park Nicollet Foundation.