On this episode, Dr. Karen Nelson is joined by Dr. Andrea Zuellig, PHD, LP. Karen and Andrea discuss binge eating disorder, one of the most prevalent eating disorders impacting a wide variety of people. They'll discuss signs, symptoms, and treatment options for those struggling with binge eating disorder as well as useful tips for families and friends to help support their loved ones.
On this episode, Dr. Karen Nelson is joined by Dr. Andrea Zuellig, PHD, LP. Karen and Andrea discuss binge eating disorder, one of the most prevalent eating disorders impacting a wide variety of people. They'll discuss signs, symptoms, and treatment options for those struggling with binge eating disorder as well as useful tips for families and friends to help support their loved ones. Click here for a transcript of this episode.
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. Andrea Zuellig. Andrea is a clinical psychologist here at Melrose. Today, we will be discussing binge eating disorder, one of the most prevalent eating disorders affecting a wide variety of people. We will discuss signs, symptoms, and treatment options for those struggling with binge eating disorder, as well as useful tips for families and friends to help support their loved ones. Now, before I begin, I invite you to take a deep breath and join me in this space.
Dr. Karen Nelson 01:12
Well, welcome Andrea, welcome to the podcast.
Dr. Andrea Zuellig 01:15
Thank you. I'm so happy to be here, Karen.
Dr. Karen Nelson 01:17
Well, before we get started talking about the topic today, I would love it if you could introduce yourself and tell me a little bit about your role here at Melrose.
Andrea Zuellig 01:26
Absolutely. So I am a clinical psychologist, I am also the clinical lead of the Binge Eating Disorder Program at Melrose. And then I am also a higher level of care therapist in the inpatient residential and partial day treatment programs at Melrose.
Dr. Karen Nelson 01:42
Let's maybe just start this discussion on binge eating disorder. And let's maybe start with the basics, almost operational definition, right, like we learn about these big words, the definition of binging. You know, I was chatting with a patient the other day, and we were talking about the use of the word binge. And how we use that word a lot in today's culture. We’ll say, ‘Oh, I binged Netflix,’ or ‘Oh, I binged this TikTok or whatever.’ Kind of this overconsumption of something. But we do have a clinical definition of what is binging. Can you share that with us?
Andrea Zuellig 02:19
We do, absolutely. A binge--so when we talk about with eating—a binge is really eating a very large amount of food in a very short period of time. So we're not talking here about overeating. We're not talking about maybe like, a cupcake and a half. Okay, which to me, just sounds like a nice day. Yes, but we're talking about, you know, maybe like a half a sheet cake at a time, we're talking about several portions of food at a time, bags of food, things like that. Stuff, that doesn't necessarily make sense. And people really do feel out of control while they're eating it. They tend to eat very rapidly and quickly, they might not even taste the food. They tend to have a lot of shame around it and guilt afterwards.
Dr. Karen Nelson 03:12
I like that distinction that you're making, also, about there is a difference between overeating or maybe just, you know, having that cupcake and a half in binging. That someone who is struggling with binge eating disorder, it's also associated with large quantities of food. But I hear you talking about the emotional piece of, you know, feeling overwhelmed or out of control. Does that resonate?
Andrea Zuellig 03:39
Absolutely, a lot of my patients will talk about almost feeling like they have this emotional hole within them that they need to fill, or satisfy. Almost like this itch that needs to be scratched where they really do not feel satisfied, until they actually feel uncomfortably full to the point of bursting. And then unfortunately, that satisfaction only lasts a very short amount of time, and then they feel tremendous amounts of guilt, shame, depression, and that often then cycles into another binge.
Dr. Karen Nelson 04:11
The thing that comes up for me, again, I was chatting with someone yesterday and we were talking about the function of the binge, and how the binge becomes an expression of some of their emotional pain that I am struggling and I'm feeling overwhelmed and I might not know what to do. And then the eating disorder telling me to engage with this food in some particular way.
Andrea Zuellig 04:35
And when you think about it, just even in our society, what is more soothing than food, right? Like, you know, all of the commercials that we see, there's so much emphasis and power around food and family and love. And for so many people they actually start to feel that almost that food is love food is reward. You know what, ‘What do I do when my child gets some reward? We go out for ice cream.’ You know, what do we do with families? We all gather together and celebrate. I think that that becomes very twisted in our society and minds. And food is wonderful. I never want to say that food is bad. Food is great! We should celebrate with food, we should love to be with our family and friends and be able to celebrate those traditions. And at the same time, if you're alone and lonely and having all those emotions, it's a really quick fix.
Dr. Karen Nelson 05:34
I think also what is very characteristic of someone who is struggling from an eating disorder versus someone who is not, that overeating behavior is then associated with shame, guilt, remorse. A lot of negative self talk happens after that binge behavior. So I used this behavior to potentially manage this discomfort that I was feeling. Now, I actually don't feel better, though. Now I feel almost maybe even worse after engaging with that behavior.
Andrea Zuellig 06:04
Exactly. And I think that that can be incredibly disheartening for people because then they feel like, ‘Well, what do I have to go on, then? Where are my coping mechanisms? How can I cope with life? Look, I'm trying to cope, I'm doing the best that I can. And then look, I've binged, I've I failed again.’ You know, particularly according to all the messages that we get in society about control and weight, and shape and thinness.
Dr. Karen Nelson 06:32
The isolation and despair is overwhelming for a lot of our patients. And oftentimes we hear as therapists, that's the place that the eating disorder shows up. I share all the time, I haven't met anyone ever that wakes up and says, ‘You know, I hope I have a really bad day today. And I hope no one calls.’ Right? Like, never have I ever. And you and I've met a lot of people. So it makes sense that I want to feel better.
Andrea Zuellig 07:02
Absolutely. I mean, who doesn't? That's right. That's right.
Dr. Karen Nelson 07:05
And so, you know, helping our listeners understand that binging is potentially a way that our patients, you know, may feel like, ‘Hey, I'm trying to solve this problem of isolation and despair.’ But it actually doesn't solve the problem. What I know, especially around eating disorders, as sometimes there's misinformation or almost confusion, when we start talking about eating disorders. So talking specifically about binge eating disorder, can you tell us what might be some of the signs or symptoms that someone might be struggling with binge eating disorder?
Andrea Zuellig 07:43
Yes. I think that one of the most common misconceptions that people have with binge eating disorder is that they often assume that anybody that is overweight, or obese struggles with binge eating disorder. And really what we see is that that is actually not the case at all. In fact, only, I think the statistics are only maybe 30% of overweight or obese people struggle with binge eating disorder. And so I think it's really, really important to know that differences in size does not indicate an eating disorder. That's a huge misconception that people have in terms of signs and symptoms. Really, people with binge eating disorder are the diagnosis means that they basically eat within a two hour period, a much larger quantity of food than the average person. Now, this tends to happen once a week or more, it has to happen at least on average of three months for them to actually get this diagnosis. But even more important, I think, than the amount of food, has to do with the process of how they're eating it. So people who binge tend to eat very rapidly. Sometimes they don't even taste the food, because it doesn't even really have to do with eating the food anymore. It has to do with getting the food in, getting it finished, and feeling like it's done. They might eat foods that might not be typical, what people might see as typical binge foods, usually those are carbs and sweets. But people will also binge on frozen vegetables. Because again, it's not just about the food, it's about the process and what function that psychologically serves for people.
Dr. Karen Nelson 09:30
Let's talk about the potential causes or what might trigger urges to engage in binge eating. Help us know about that.
Andrea Zuellig 09:40
Oh, boy, there are so many I think that it this gets at our society as a whole and how our society feels about weight, and size, and food. One of the big triggers, obviously, is how people deal with their emotions, and the coping mechanisms that they have for dealing with their own emotions, and how much they can tolerate that, and what they do with that. How they feel about their own body, how they feel about food. Similar to other eating disorders, we see a lot of people dieting and restricting to try to control their shape and weight, feeling badly about their own shape. And so we often see people restricting to or dieting to try to lose weight. And then at some point, they become overly hungry and they end up binging
Dr. Karen Nelson 10:37
We share, you know, research and evidence. We're an evidence-based clinic and we believe in evidence-based treatment. And there's a lot of research that indicates restriction can lead, and does lead, to binging
Andrea Zuellig 10:50
Yes, absolutely. Absolutely. And yet, what do we get in our media all the time? You know, it's like, I'm bombarded by ads on my social media feed all the time. That's intermittent fasting, and the latest diets, and all these things to help people shrink themselves and get smaller and not accept the natural size and shape that they are meant to be, just naturally.
Dr. Karen Nelson 11:15
That's right. So diet culture, and this idea about shifting or needing to shift, that there's only one right body, that absolutely plays a part in potentially the development of urges around binging.
Andrea Zuellig 11:30
Absolutely, absolutely. I feel that the last acceptable -ISM in our society is fatphobia. You know, weightism, shapeism. And it's amazing the amount of people that I know that would never comment derogatorily about somebody for their culture, race, anything like that, but they will have no problem with talking about ‘Oh, that person's not taking care of themselves,’ or ‘Look at how much weight that person gained,’ or ‘Wow, I hope that you never look like your Aunt Lydia,’ or things like that.
Dr. Karen Nelson 12:08
Oh my gosh, a lot of our patients come to us with, you know, just oodles and oodles of stories, right? Of how they hear this, these messages about that their body is not okay, that there's only one acceptable body shape, and the shame that shows up for a lot of our patients,
Andrea Zuellig 12:27
And even getting messages sometimes by professionals that skip meals, starve yourself, do whatever you can to get to be a lower weight. Even if that means that then you don't have proper nutrition. A lot of our people with binge eating disorders actually are malnourished. And people don't realize that.
Dr. Karen Nelson 12:44
Beautiful point. I love that point. Again, so much misconception. And when the focus only becomes on a person's weight, we talk about it as, weight is one data point, but it is not the full picture of someone's health profile. And so, making the assumption that someone's healthy or unhealthy only based on what the scale is saying is kind of a misrepresentation of that person.
Andrea Zuellig 13:10
And one point that I also wanted to make is that, I know that we're talking about weight a lot, but that 60% of people with B.E.D. tend to be overweight or obese, but that there also are 40% of people with B.E.D are normal weight. So many people think that people who are overweight or obese have binge eating disorder when that is not the case at all.
Dr. Karen Nelson 13:34
Well, body image is actually you know, a topic that we do talk about in conjunction with healing from binge eating disorder. How would we help someone who is struggling with binge eating disorder move to a place of a potential better body image?
Andrea Zuellig 13:51
Honestly, I feel like so much of it is having people be able to embrace their life, you know, embrace their life the way it is. I've talked to so many people where--it's so hard it actually breaks my heart a little bit--where there's so many things that they have not done, because they are self-conscious about their size, and shape, and feel like other people are going to judge them. And people who have missed out on family vacations, skiing, vacations, snorkeling, swimming, anything, you know, even like reunions, and they end up living a very isolated lifestyle which only exacerbates the binging because they are so depressed and sad. And that's so heartbreaking. And I feel like there's nothing more empowering than being able to tell people, ‘Hey, if you don't like the way I look, maybe you're the one with the problem.’
Dr. Karen Nelson 14:51
Wow.
Andrea Zuellig 14:52
Because there's nothing wrong with my body.
Dr. Karen Nelson 14:55
That's right.
Andrea Zuellig 14:56
It's my body.
Dr. Karen Nelson 14:56
It's my body. I get to choose.
Andrea Zuellig 14:58
Why does anybody have the right to judge my body, when it’s my body?
Dr. Karen Nelson 15:02
We often do have a distinction, and we talk about it here at Melrose, that, you know, treatment and recovery from binge eating disorder--weight is not a component of that.
Andrea Zuellig 15:13
And I do think that it's very difficult sometimes for our patients with binge eating disorder who are overweight or obese, when we tell them that ultimately, right now, weight loss is not our goal. And that the it's virtually impossible for anybody to be working on losing weight, and working on healing themselves from an eating disorder at the same time, just does not happen. And I think that people really need to realize that, particularly significant others. Family members need to realize that. They need to have the space to work on their eating disorder, develop a healthy relationship with food, and then figure out what they need to do. The biggest things that I hear from people, from patients, is saying, ‘I just want to have a healthy relationship with food. I want to be able to enjoy food. I want to be able to go out and eat with my family without feeling like people are judging me, or that I shouldn't be eating this, or that I might be eating too much, or not enough.’
Dr. Karen Nelson 16:19
I love that a healthy relationship with food. Yeah. And that's absolutely what we're here at Melrose to help you find. You bet. Let's transition and talk about what does binge eating disorder treatment look like.
Andrea Zuellig 16:35
So at Melrose right now, what we have is a 17 week group that, right now in the pandemic, it's a little bit different, because it's virtual. And basically, the first hour is with one of our therapists or psychologists where they are going through a number of CBT skills, where they're teaching people really about binge eating disorder, about ways to manage these emotions, besides binging. Looking at triggers, looking at cues, looking at body image, really teaching about people's anxiety and how to cope with that. Talking with--there's a family and friends night actually where family and friends are invited so that we can educate them about binge eating and ways that we can support them and that they can support their loved ones.
Dr. Karen Nelson 17:40
So the group, it's a group format. And it is a cognitive behavioral therapy group. So it uses skills, it teaches clients applicable skills to use when they might be feeling big emotions, which may have previously led them to want to binge. It's one thing to maybe see a skill written, but it's another thing to have a conversation of ‘How might I use this?’ So the skill might be, you know, ‘How do I even know when I'm binging?’ ‘How do I have awareness about that? What might trigger me to want to engage with a binge?’ And we will talk very specifically in the group about applicable things to look for, and utilize in your own life.
Andrea Zuellig 18:26
Exactly. Even really looking at individual's hunger and fullness cues. How can you tell when you're hungry? How can you tell when you're full? It's different for each person. There's fullness after binging, which is usually fullness to the point of bursting, but then there's satiety, which might be that ‘Hey, I could still take another couple bites, but I'm okay.’
Dr. Karen Nelson 18:48
So really helping patients learn new ways to maybe experience food, or eat, or pay attention to their hunger and fullness cues. All of that is a part of a group, is what it sounds like.
Andrea Zuellig 19:00
Right? Right.
Dr. Karen Nelson 19:02
So treatment for binge eating disorder is not a diet.
Andrea Zuellig 19:08
Oh, I love that. Ding ding ding ding. Can we like get bumper stickers? Pass those out? That's great.
Dr. Karen Nelson 19:17
I think that's your and my side gig right there. That's right. Again, speaks to the misconception. Where, if someone lives in a fuller body or is overweight, this belief of if you just lose weight, then it will all be okay.
Andrea Zuellig 19:32
Yes. And sometimes I think unfortunately, that belief happens more even with support people than the patients themselves. I've heard of, you know, parents, spouses and well meaning family members saying ‘Hey, you don't seem to be losing weight.’ And that's like, ‘Okay, you need to stop talking about that person's body.’
Dr. Karen Nelson 19:55
That's right. That's right. That's right. Well, I think it speaks to, again, that some of the misinformation that inherently body shape or weight equals health. And that eating disorders-- we talk about it all the time--eating disorders are not about food. Eating disorders are about our relationship with food. And so healing binge eating talks about kind of the function that food was serving for that person. What might a skill look like? That we may present to a patient to manage some urges around binge eating or a skill that we might give someone to manage urges around binge eating disorder?
Andrea Zuellig 20:41
One of my very favorite skills is urge surfing, Urge surfing is a fantastic skill for binging. So urge surfing is a skill that was actually originally used for smoking cessation. And what people found was that from the time that a person first started to want to smoke a cigarette to the time that they were basically saying, ‘Okay, I am ready to run out to a convenience store in minus 20 degree weather, to grab some cigarettes,’ that period of time from its start point to its peak lasts about 20 to 30 minutes. If that person is able to go for that long without engaging in that behavior, then the urge starts to go down. Now, unfortunately, it doesn't go down to nothing. But the good news is that it tends to go down enough so that it's much easier to manage that urge using other coping mechanisms. So what I tell people to do, and everybody thinks I'm nuts, my patients hate this. But what I do is I actually tell them to make a list of 100 things. That's where they think I'm crazy. But honestly, if they can even come up with 50 things, or even 25 things, that's fantastic. But a list of things that they can do that they can use as a distraction from when they're first starting to think about binge, to about 20 to 30 minutes afterwards. So within a 20 to 30 minute time period, what kinds of things can they do to distract themselves, where they are not in a kitchen, they're not around food? Ideally, they're with other people, they're engaging in things. And the most important part of this is that their mind is engaged. Not things where they're mindlessly watching TV, or mindlessly doing things and they're still thinking about, ‘Oh, I really, really want to go eat that X, Y and Z.’ But where they can do something where their mind can refocus, their mind can jump tracks, so to say, they can get themselves a little distracted. And it sounds like a Band-Aid, but it works.
Dr. Karen Nelson 22:53
It really works. It really does. And patients--I love it that you're saying, you know initially maybe presenting that or hearing that in group, they're thinking ‘Are you kidding me?’ We often say ‘Give it a go.’ Right? Just give it a go. And that's the power of group, being able to come back that following week and explore with the other participants. ‘How did it go? What worked for you? What skills did you put on your 100 lists that Andrea made us write, thank you, Andrea?’
Andrea Zuellig 23:22
My favorite moment in groups is when somebody says, ‘Okay, I thought that skill was the stupidest thing I've ever heard. And there was no way I was going to do it. But I did it. And it worked.’
Dr. Karen Nelson 23:32
And it worked. I love that. And I think I often use the word, being curious and experiment in therapy, because that's what we want. We're just going to be curious, Let's try it out. I can't know if it's if it's going to work unless I literally try it.
Andrea Zuellig 23:46
Yeah, what's the harm in it? That's got nothing to lose. And if it doesn't work, you try something else.
Dr. Karen Nelson 23:50
Moving on to, if I have a family member or a loved one that has binge eating disorder, what might be the best way for me to approach that person?
Andrea Zuellig 24:03
Rule number one?
Dr. Karen Nelson 24:07
I'm ready.
Andrea Zuellig 24:07
Do not talk about their weight. Rule number two, do not talk about their weight. That's it. I mean, in all seriousness, though, I mean, ‘I've noticed that there seems to be some difficulty with your relationship with food.’ So really focus on the behaviors and most importantly, in a non-shaming way. People with eating disorders and, especially I would say people with binge eating disorder are so shame vulnerable, I would say, and pushing that shame button actually makes people so much more likely to hide away and not seek treatment. And so if somebody is able to say to their loved one, ‘Hey, I've noticed that your eating seems a bit irregular. I'm a bit concerned about that. Are you okay? You see more down you see more anxious, you see more upset about yourself, you don't seem to like yourself, I'm worried about you.’ I think in a loving way, I think that when people approach this in terms of ‘You're gaining weight,’ or ‘I'm worried about your health,’ or ‘You're going to have a heart attack,’ things like that. I think that that tends to be more shaming. And even though it does have the best of intentions, and that person tends to feel more guilt and feel more out of control and not want not want to admit that they have a problem.
Dr. Karen Nelson 25:39
I love how you described it as talking about, ‘I've maybe noticed that your relationship with food maybe has shifted or changed.’ Another warning sign that we might look for is people not participating in meal experiences. Sometimes that's a misconception that, you know, people who are under eating, maybe avoiding meal experiences. Sometimes people who are struggling with binging don't want to eat in public. They don't want to participate in the, you know, potlucks and they order something very, very small. And then you know, maybe going home and binging. So a lot of shame around eating experiences. And so, letting people know, ‘I'm noticing something, I might not even know what I'm noticing. But I care about you is what I hear you saying?’ Yes. I love that. I love that. What are some other things friends or family can do to support someone with binge eating disorder?
Andrea Zuellig 26:40
Eating with them can be very, very helpful. Offering to eat with them, or even insisting. ‘Let's do this. We're going to make this together. Let’s go out to eat, and let's, you know, cook together. And let's all sit down, eat together.’ I think that those things are very, very important. Really, the importance of regular eating is so important with binge eating disorder. You nailed it. Karen, when you said that people have this misconception, they forget about this. But so many times people with binge eating, really get into this pattern of restriction and not eating not eating enough, and then binging when they're alone. It's really common to hear family members and friends say, ‘I didn't know that they had a binging problem, because I never saw them binge.’ And my attitude to that is a bit like, well, of course you never saw them binge
Dr. Karen Nelson 27:37
It lives in secrecy.
Andrea Zuellig 27:40
That's the whole that's one of the criteria of binging, actually, they do tend to binge alone. And being able to take away the shame of eating, being able to make food normal; eating desserts with them; not talking about food in good or bad ways; redirecting the conversation when other people are talking about that; checking your own views about weight, and size, and worth and food. It's so important to not be talking about that. In general. I mean, we've got lots of other very, very important things to talk about. There's lots of stuff going on in the world. I don't want to waste my time talking to people about feeling fat.
Dr. Karen Nelson 28:32
That's right. That's right. I love it that you're talking about how friends and family can manage their own derogatory talk about bodies. It's probably one of the most frequent things I talk about as someone's moving through treatment, of maybe how do I let mom know that when she talks so derogatively about her body, it impacts me the person who's working to recover from their eating disorder.
Andrea Zuellig 28:58
Yes. And support people often don't know that. They often think, ‘Well, I'm not talking derogatorily about her body. I'm just talking about my body. So why, why is it so upsetting?’ But it's still emphasizes shape, it still emphasizes this idea that people should be smaller, that there is something to be concerned about there. And it draws attention to that, and that people aren't okay the way that they are. And it's really common for people to think, ‘Oh, well, she doesn't like her body was she think about my body?’
Dr. Karen Nelson 29:35
That aspect of fatphobia comes up, this space where we are very critical and have a lot of, again, misconceptions about people's bodies.
Andrea Zuellig 29:47
Yes. And people's personality characteristics because of their bodies, which is ridiculous. We were talking a bit earlier, off mic, about how you know people aren't all 5’7 or 5’9 or 6’0 tall. And so why would we expect people to all be one body shape or size? Like, isn't that weird?
Dr. Karen Nelson 30:11
That's right. That's right. It is a, you know, really kind of unique. When you stop and think about it, it's like, ‘Well, yeah, you know, I don't go home and hate on myself. Because, you know, I'm not 5’7, right? I will always be 5’4 no matter how big my shoes are, right?’ Like, right my body is, that's the height of my body. But we're sometimes fed this belief that if I do it just right, or if I only eat these foods, I can shift my body into being this one acceptable size. Let's talk about what might be some good things to say to someone to encourage them in their recovery.
Andrea Zuellig 30:52
I think it can really help people to hear that people love them, no matter what they look like. And that, that people are concerned about them, and that they want them to get better, because they want them to live a happier life. That they want them to be more engaged with their family and loved ones, or they want them to be able to feel better about themselves, or have less depression, less anxiety. Less talk about body and weight. That is really not helpful. But being able to encourage people to get help, and to stay in treatment, really, because that's a way of living their best life and living their best self.
Dr. Karen Nelson 31:40
So is there hope for recovery for someone who is struggling with binge eating disorder?
Andrea Zuellig 31:46
Always! 100%! Absolutely. We see it every day.
Dr. Karen Nelson 31:51
That’s right. That's right. Absolutely. There is hope and healing is possible. Absolutely. What might that look like? You know, have patients ever described what that looks like? Or what that feels like to them to be on the other side of, you know, struggling with binge eating?
Andrea Zuellig 32:08
People talk about this tremendous sense of freedom. Being able to eat what they want, when they want. Being able to not let food or fear dictate their life choices. Being able to be sometimes self conscious, like the rest of us are, but not letting it determine what they might do and what they don't do.
Dr. Karen Nelson 32:30
I love that. I love that. Andrea, is there anything I haven't asked you that you'd like to say?
Andrea Zuellig 32:37
I think, don't wait. If you think that you have a problem. If you think that you have an eating disorder, that you're struggling with binging don't wait, you know, don't wait to get treatment. Don't wait to live your life. So many times I see people that they tell themselves, ‘Oh, well, I just need to lose some weight before I do this or do that’ or, you know, even before they seek treatment, because they don't think they're sick enough. And the idea is getting help. Now. For those that might be my patients that might be listening, they might know that I have a ton of magnets outside my I love it. And one of the magnets says, you know, don't wait to live your best life. And I firmly believe that and really being able to heal yourself is such an important part of that.
Dr. Karen Nelson 33:29
Thank you, Andrea, so much for joining me today. It's been just an absolute joy sitting with you.
Andrea Zuellig 33:34
Oh, thank you.
Dr. Karen Nelson 33:37
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