On this episode, Karen is joined by Dr. Linsey Utzinger, a clinical psychologist and specialist on eating disorders and children at Melrose. This episode will focus on how eating disorders can show up in children and teens as well as the important role that parents and guardians play in the recovery of their children.
On this episode, Karen is joined by Dr. Linsey Utzinger, a clinical psychologist and specialist on eating disorders and children at Melrose. This episode will focus on how eating disorders can show up in children and teens as well as the important role that parents and guardians play in the recovery of their children.
Click here for a transcript of this episode.
Dr. Karen Nelson 00:00
[Intro with piano music] 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 I'm joined by Dr. Linsey Utzinger. Linsey is a fellow clinical psychologist here at Melrose. We'll discuss how eating disorders can impact children and young adults, and the important role that parents and guardians play in their recovery. If you are a parent or a guardian with a child suffering from an eating disorder, I hope you will find this conversation not only helpful, but empowering as well. Now, before I begin, I invite you to take a deep breath... and join me in this space. Welcome to the podcast, Linsey. I'm so excited to be talking with you today.
Dr. Linsey Utzinger 01:14
Thank you. I'm very excited to be here.
Dr. Karen Nelson 01:16
Can you describe your role here at Melrose?
Dr. Linsey Utzinger 01:19
Sure! So, I'm a clinical psychologist, which means that I provide clinical care to children, adolescents and adults who have been diagnosed with eating disorders. My background in eating disorders has been, I think just prior to starting grad school and overtime that has included everything from being a research assistant to eventually being a clinician on some research studies, doing research, teaching, training, and now a lot more clinical work. It's always been in eating disorders and I can't tell you why... [laughs] ...other than it's, it's interesting to me, and it's meaningful work. Yeah, I agree.
Dr. Karen Nelson 02:00
Maybe it will take kind of a note. You know, today as we're chatting, we're probably going to interchange the word "kids" and "children", right? And adolescents... Do you have any kind of definition that you might use as you use those words to talk about kids or children or... I love that. Absolutely. Well, I also think too that piece of just naming sometimes we don't really know why we're drawn to something but it feels good when we're there.
Dr. Linsey Utzinger 02:02
I think "children" and or "adolescents" is fine. But I think it's important to note that we really are talking about a wider range of people. But I think in terms of what we're talking about today it will be that kind of age group between young children to young adults.
Dr. Karen Nelson 02:45
Well, maybe let's focus a little bit on transitioning and talking kind of specifically about eating disorders and children, right? And let's maybe move into this idea of how do you diagnose a child with an eating disorder? What might that look like?
Dr. Linsey Utzinger 03:03
I think I might even back up a little bit and start with, you know, what are families actually looking for before we even are able to make a diagnosis? Um, because they they look different in different children, and the age might impact that or other things. And eating disorders are sort of sneaky. And they like to fly under the radar and are hidden, and so oftentimes families don't see them. And that's by design. Eating disorders are built that way. So things that families can maybe look out for are changes in eating behaviors, weight loss, or preoccupation with food or weight or appearance. Sometimes families can't visually see weight changes, and that's not the only thing that would indicate there's a problem. So sometimes it's these more behavioral things. For example, kids saying, "I'm not hungry", or "I already ate," or "I'm going to eat with my friends," or kids starting to comment more on body or food related things. Those might be some kind of... I wouldn't say warning signs, but indications or things they may want to keep their eyes out for.
Dr. Karen Nelson 04:12
Absolutely. I love it that you commented on how eating disorders are sneaky, and especially with children, right? That, you know, sometimes what I notice is parents will share with me they just get a feeling that something might be different and will potentially bring that to you maybe through a story or some kind of anecdotal, you know, ideas of like, "Hmm, My son isn't coming down to dinner anymore," or does that bring up anything for you? Or what do you think about that?
Dr. Linsey Utzinger 04:41
Right, I see so many families who didn't know, right? And maybe even feel badly about that, like, "Oh, I wish I would have caught it sooner", but there's really no way they could have known. And so oftentimes families are made aware by friends' parents or their children's friends... or there start to be enough things that are happening that kind of raise concerns and ultimately then they end up coming to see us.
Dr. Karen Nelson 05:10
How does body image play a role in eating disorders?
Dr. Linsey Utzinger 05:14
It's funny because on the face of it that should be such an easy question... ...But it's really not. You know, it can be a part of the development of an eating disorder, in some, but not all cases, right, they all might start off differently. I like to tell families that eating disorders sort of develop as part of a perfect storm where maybe there's a genetic vulnerability or underlying neurobiological thing. And then on top of that you have the society that we live in and other cultural things and other events or situations that kids have been in, that they've experienced, and it all comes together at just the right time or in just the right way; And there we have an eating disorder. And so body image may or may not be a part of that. It sometimes can come later, but I think actually what is the most important piece of it is that we don't need to treat body image concerns in order for kids to get better. So actually, at the beginning of treatment we don't focus on that at all because typically what led to the eating disorder to begin with isn't what is maintaining it now. Those factors and mechanisms might be completely different, and so we're just going to focus on the here and now. Make sure children get fed, get back on their growth curves, are healthy... And then later on we'll sort of tackle various different issues. And again, that might not include body image, right? As long as kids learn that they need to eat to stay healthy and well and make good choices, body image concerns might not actually be as important as they might have seemed at the beginning.
Dr. Karen Nelson 05:18
I know [overlaps] Very good point. What comes up for me talking about body image in, you know, my work with, you know, past patients, is this idea of social media. What... tell me your thoughts on that, about just the explosion of social media over the past even five years, I would say, and how that potentially, you've watched that impact your caseload.
Dr. Linsey Utzinger 07:19
Right, and it is something that I do talk more about in treatment now than I used to. And I think it's hard to ignore the fact that it is a part of... it's a part of it. It's a part of body image concerns. It's a part of maintaining eating disorder, thoughts and behaviors, right? Because kids are seeing and comparing themselves to their friends, to celebrities, to influencers on Instagram, or Tiktok, or whatever it is, they're watching. And so we do want kids and families to be really thoughtful and really careful about social media use. So for parents, I would wonder Who are your kids following? And how do they feel as a result of that? And are they, especially if an eating disorder is developing or an eating disorder is already there, those are things that can just reinforce body dissatisfaction and feeling bad.
Dr. Karen Nelson 08:16
Very good point. I hear you really talking about that process of being a consumer of social media, right? And how our children might not have those skills on how to consume it; and maybe sharing with them how to do that? or what do you think about that?
Dr. Linsey Utzinger 08:30
Right, exactly. And actually, adults! I think that's true for everybody. Right? So having parents have conversation with their kids, having parents be aware of who they are following or what information they might be getting from that. Again, sometimes it's hard because it might be benign things kids can compare themselves to old pictures of themselves. They don't even need social media. Right? So I think, yes, social media is a problem or is a concern, but it also can go beyond that. So being, as you say, a "good consumer" of that can be helpful.
Dr. Karen Nelson 09:07
Absolutely. I think we were just bombarded with so many different images. You know, not only as children and as adults, and we can... we can easily get sucked in to different images or messages. And no wonder we can feel overwhelmed as adults, let alone a potential adolescent or kid. Well, let's actually transition and talk about what is the best treatment for eating disorders in kids and teens.
Dr. Linsey Utzinger 09:34
So the gold-standard treatment is family-based treatment. The acronym is FBT. It's been fairly well researched and has been shown to be the most effective treatment that we have right now for kids. You know, unfortunately, it doesn't work all of the time. But when it works, it works. And families have been able to do it and really help their kids get better.
Dr. Karen Nelson 09:56
How might family-based therapy be different than treating an adult with an eating disorder?
Dr. Linsey Utzinger 10:04
When kids are young, they live in their houses with their families. And, again, like we talked about before, with, especially with anorexia... kids with anorexia sometimes want to hang on to a part of that illness. And so the, the desire for them to get better sometimes isn't there, sometimes it is. But sometimes it's not. And so parents are actually the ones that have the power to help them get better even when they don't want to. And so the fact that kids live in their... in their homes with their families, and families can be involved in treatment. And when I say involved in treatment, I mean heavily involved in treatment, especially in the beginning. Parents are doing a lot of the work at the beginning and we rely on them to do that because they love their kids. And they've raised their kids up until this point. And so they actually know what to do. They don't feel like they do, typically. And they they want our support, and we provide that support. But really, my job usually is just to help them... help coach them a little bit but really more so use the skills and tools they already have as parents to help their children get better from this particular thing.
Dr. Karen Nelson 11:17
Absolutely. Can you break it down a little bit of what family-based therapy entails?
Dr. Linsey Utzinger 11:23
Sure. How it works is that in the first part of treatment we really put the onus on parents to take control over everything that has to do with the eating disorder, starting with food and eating. So that would mean that parents become responsible for making sure their child, regardless of their child's age, is getting three meals and three snacks in every day. And again, because eating disorders can be so sneaky, we can't rely on their children to tell the truth about whether or not that's happening. And so we actually also want parents to monitor it all. They have to see it with their own eyes. In fact, I often tell families, "If you don't see it, it didn't happen", or we can't count it as having happened. So parents have to see it. And then we also asked parents to monitor for other kinds of eating disorder behaviors as well. If those are happening or if there's a suspicion about them. So monitoring for purging, monitoring exercise, setting some boundaries, and expectations with their, with their children to make sure they're getting what they need.
Dr. Karen Nelson 12:29
So that can be really difficult for parents is, is what I'm hearing... That there, there's a lot of changes that may need to happen in those households as family-based treatment starts.
Dr. Linsey Utzinger 12:40
Correct. And that's what makes it so difficult, right? Parents come in expecting us to help or wanting us to help, and here we sort of turn it around and say, "Okay, but you're going to do all this work." But the reality is that kids are with their parents more. And seeing us once a week is not going to actually be able to achieve that change. Parents... parents, though, can make it happen and they do. But yes, it's incredibly difficult for them to change their schedules or shift things around. Oftentimes, there's other siblings in the home. But I often try to tell families too, that it's temporary. If you can make these temporary changes to save your child's life, let's do them. Do whatever you need to do to make this happen. And it's pretty cool to see that families do that.
Dr. Karen Nelson 13:28
That's amazing. Tell me about how you may empower parents and share some of that space of "I hear this is hard and I'm going to empower you to do it."
Dr. Linsey Utzinger 13:38
Sure. You know, in FBT, in family-based treatment, we often use various different analogies, and one of them is this cancer analogy where we say, "You know, your child basically developed this eating disorder. Could have just as easily been cancer. And if your child with cancer didn't want to get better, was fighting you, did not want to go to chemo because they were going to feel nauseous, lose their hair, get sick. So they're fighting you, what would you do as parents? Would you let her skip those appointments? Or not take the medicine? Or would you even give her half of the dose of the medication?" And parents often will respond to that by saying, "Well, no, we're gonna make sure she's getting the full dose and that she's getting to those appointments." And in anorexia and other eating disorders, it's the same idea, right? Your child didn't ask for this. And yet this particular disease makes them not want to get better sometimes. And so you as parents are going to have to do it. And again, I think parents can parents can see that when kids have eating disorders every organ system in their body is impacted. There are consequences. Luckily, many of them are reversible if we turn things around, but kids brains are also impacted. And so what that means in terms of cognitive functioning or ability to think clearly, really clearly is that they really can't. But I do often tell families that it is possible that their kids will be fully recovered. And what that means is that because parents worry about that, like, "Is this something my child is going to struggle with forever?" And no, it doesn't have to be. And it isn't. And the cool thing about working with kids is that I see that happen. I have kids who have recovered and even by the end of treatment they can't recall and don't remember a lot of things that happened. Parents remember, because they were also stressful for parents. But the kids themselves don't. And they have moved on completely with their lives. And that is so cool to see. And so I always want families to, to know that that is possible. And that is the goal.
Dr. Karen Nelson 15:47
For sure. For sure. Well, I think that aspect of just instilling hope, right? That change can happen. And yes, this might be hard. And we can do hard things, right?
Dr. Linsey Utzinger 15:58
Right
Dr. Karen Nelson 15:59
That can be very true.
Dr. Linsey Utzinger 16:01
There's kind of this, it's a J curve, where when parents start this process, right? They shift the rules and kind of create this structure where they're closing all the loopholes for the eating disorder to get through. The eating disorder is not going to be happy about that. And the eating disorder is going to push back in as many ways as it possibly can to see if they can get away with things, right? And so if parents aren't consistent, for example, and the eating disorder behaviors kind of sneak through, it's going to allow the eating disorder to continue to thrive. And so one of the things I encourage parents to do is, you know, even though it's going to be hard, and it's actually going to feel like you're not doing the right thing. I look for that. I usually see that if it gets worse right away, because parents are being consistent doing this, that's a good sign. I I tend to worry when things are going too smoothly. Because I'm thinking, "Well, what is the eating disorder getting away with? How is it flying under parent's radar? It must be."
Dr. Karen Nelson 17:02
Absolutely. So acknowledging that space of when you're, when the parents are really challenging the eating disorder, the child or adolescent... sounds like they're probably pretty upset?
Dr. Linsey Utzinger 17:14
Yes..?
Dr. Karen Nelson 17:15
[laughs]
Dr. Linsey Utzinger 17:15
Yep, that doesn't always happen. Again, with the variation in how this can look, some kids are naturally just more compliant kids. They might be less likely to push back. They might sit at it at a dinner table and eat the food that parents are giving them but in tears, with extremely high anxiety, and parents need to sit with them and warmly but firmly coach them through that meal, right? "You can do this we love you take another bite," and other kids... [laughing] Right? [overlapping] "...Will push back much more hard than that. Other kids might throw food, throw tantrums, threaten... various different kinds of behaviors that are scary to parents. And when eating disorders engage in those kinds of behaviors like threats, it sometimes gets parents to back off, in which case those threats or throwing the food or leaving the house, that becomes effective. And so part of my job is to help coach parents to understand that and to not let those threats work...
Dr. Karen Nelson 17:50
That's right [overlapping]
Dr. Linsey Utzinger 18:09
Right. So we often help parents to learn how to not negotiate with the eating disorder.
Dr. Karen Nelson 18:26
Well reminds me of, you had mentioned, that eating disorders can be sneaky. And so kind of empowering the family to acknowledge that the eating disorder may have a different agenda than recovery... and empowering the family to keep moving forward.
Dr. Linsey Utzinger 18:42
Right? Absolutely. Families sometimes, I think, struggle with the fact that we are not addressing the psychological issues or the body image, right? They come in and we're trying to do this, and sometimes they get stuck thinking, "Well, Linsey , why aren't you addressing body image? Clearly that's related." Or, you know, "Why aren't you meeting with her longer?" because the setup is usually that I'll meet with a child at the beginning for the first maybe five minutes, sometimes less, if a child really isn't engaged and they're not doing well they can't engage. Later on in treatment, and maybe we'll talk about that, I'll meet with them more and they're much more engaged and involved because they're capable of that. Their brains are healthier, hopefully by then. But we cannot focus on those things because that's not the priority right now. Kids are underweight, they have a disease that's not going to make them see the logic that they need to eat in order to get healthy and get better. So we help parents understand that right now none of that matters. We just have to make... make it happen. We have to get food in these kids. We have to get them re nourished. We have to get them back onto their growth curve. And then, once their brains have recovered, or are on the way to recovery, they might be more capable of managing some of those other things or engaging and being more involved in treatment.
Dr. Karen Nelson 20:08
Absolutely. What I really hear you talking about is kind of the priority of family-based therapy. The initial important factor is really getting the child to a place where their brain is fed, and their body is fed, right? That we can't do the higher order stuff, right? We can't talk about all the feelings in the body image if my brain is starving. I can't think in the same way.
Dr. Linsey Utzinger 20:33
Right! Exactly. That is 100% right. The reality is that eating disorders do kill people. And so if you think about it that way, you know, if we spent three months talking about body image, that would be three months that a child's brain continues to be starved, and their organ system continues to be impacted by malnutrition. That's not the right order. We want to get them healthy and well and keep them alive so that then they're capable later on of maybe it is doing this other kind of work. But maybe it's also just we want to get them back in their lives. And they're actually fully recovered and, you know, this is in their past, and they can move on, and they're eating healthy and well and growing again.
Dr. Karen Nelson 21:20
That's right.
Dr. Linsey Utzinger 21:20
So yes, that, that has to be the focus.
Dr. Karen Nelson 21:22
Absolutely. What I hear you talking about is a lot of work with parents. And so help me know, what is it like to have some of those conversations with parents about... "Okay, I'm going to ask you to do something real hard," right? And just help me know about that. What is that like in your work of working with these families?
Dr. Linsey Utzinger 21:43
Do you want to know the truth? [laughs]
Dr. Karen Nelson 21:44
Yeah! I really want to know the truth!
Dr. Linsey Utzinger 21:47
Sometimes it can be really stressful, really challenging, sometimes really sad... because again, some families have the resources and ability to navigate some of these scheduling things. Some families don't. Some families... just struggle to do this, right? And, and yet there isn't really any good alternative. And so if they can't do this we're all sort of stuck. And that doesn't feel good to anybody. And sometimes it feels really great. I've, I don't, I can't even count now how many kids and families I've worked with. But in those cases where kids get better, it's always so rewarding, and ultimately so amazing to see families do exactly what we're trying to help them do. And families just kind of do it.
Dr. Karen Nelson 22:39
They do it.
Dr. Linsey Utzinger 22:40
Yes!
Dr. Karen Nelson 22:41
That's really cool. I think, I mean, one thing I'll just add, you know, I... my specialty is adults. And so even just talking about this, I need to acknowledge that this is hard work. Working with not only the patient who is struggling with an eating disorder but working within a family, and there's just a lot of emotion.
Dr. Linsey Utzinger 23:01
[laughs]
Dr. Karen Nelson 23:02
I can't even imagine, girl, all the emotion in that room! Right? And so what I really hear you talking about is being the guide, kind of the this navigator of empowering the family, right? Holding all the feeling, and establishing this as our goal, right? That we have to have these goals. And help me know a little bit more about that... you know, kind of just the goal of therapy.
Dr. Linsey Utzinger 23:29
Yeah, so the goal of therapy, obviously, is to get children healthy and stop eating disorder behaviors. You know, when I had a patient once who told me about... it was at the end of treatment and we were talking about "Where's your eating disorder now?" And she said, "Well, it used to be in my house. [laugh] And then it kind of moved into the basement. And then it moved next door. And then it moved down the street. And then I was in kind of a gated community. [both laughing] "I love it!" [overlapping] "...It was trying to get in some times, but it couldn't. And now it's on a totally different planet." That's the angle.
Dr. Karen Nelson 24:07
Wow! I love that story! It's right! Like it just really shows the image, right, of how it was taking up space. It was occupying a lot of space in that family...
Dr. Linsey Utzinger 24:20
Yes. [overlapping]
Dr. Karen Nelson 24:20
...and with that patient. Tell me about how parents may need to care for themselves during this process of exploring family-based therapy.
Dr. Linsey Utzinger 24:31
I'm glad that you're asking about that because I think that is very important. In fact, burnout rates in family members where there's an eating disorder present are incredibly high. And so right away, you know, I think that families kind of do have more resources and more energy, and then if eating disorders become chronic or more long lasting, they lose that a little bit. They do start to become more burnt out and maybe even feel more hopeless, or kind of, or everybody's just living in the status quo of this eating disorder being present. And so early on I want parents to find ways to care for themselves, to be able to do this. And again, relying on support systems is one way: Getting enough sleep... taking care of themselves also in terms of eating. Making sure they're getting the energy that they need. Maybe even getting support in other ways. I have... I've also had some parents who are in their own therapy during this. We do also have some group programs at Melrose where parents can communicate with other families. And I think that is ultimately so helpful in families feeling like, "Okay, we're not alone. Other families are in this too, and they get it." And what I love about those two is that it gives some families who are sort of at the beginning of the process the ability to see that other families have landed on the other side. And that if that is true for these families, maybe it's true for them, too, or could be, so give's them hope.
Dr. Karen Nelson 26:04
That's right. We've talked a lot about the parents role in family-based therapy, what does family-based therapy feel like for the child?
Dr. Linsey Utzinger 26:12
So usually early on in treatment kids tend not to be a fan of me. [both laughing]
Dr. Karen Nelson 26:22
What?! [overlapping]
Dr. Linsey Utzinger 26:22
You know, and that's actually really hard for parents to see because, again, they're thinking, "Okay, we're meeting with a therapist, that therapist is going to help our child understand, you know, that she needs to eat. And here's Linsey telling us that we need to feed our child and our child hates Linsey , [both laughing] our child really is not a fan." And so sometimes families will think, "Well, we need our child to connect with their therapist. So maybe we need another therapist," when in fact, the next therapist is going to do exactly the same thing and say the same things. And so children, oftentimes early on, aren't a fan of this approach. But I, again, how I help families kind of wrap their heads around that... Because that they don't have to like it in order for it to work. And many, many, many children, at the end of treatment, can look back and say, "I hated my therapist," or "I hated my parents, I was kicking, I was screaming, I was throwing food, I was doing all of these horrible things. But thank you to all those people, especially my parents for sticking with me throughout that because they knew I could get better, and they helped me get there." And that's always so cool to hear from kids.
Dr. Karen Nelson 27:39
It's such a good point. It makes me think about how sometimes we have kind of ideas, or like a perception of what it might be like that, "Oh, therapy is this, you know, kind of dark, cozy room with a blanket and my therapist drinks tea and you know, tells me 'Oh, you'll be fine or better.'" And it really is different than that. And it can be uncomfortable and hard. And it works. Both are true.
Dr. Linsey Utzinger 28:05
Exactly. Yes, you hit the nail on the head.
Dr. Karen Nelson 28:09
So we know accessing mental health care, especially during this time of a pandemic, can be challenging. What might you say to families that are in the process of looking for treatment or attempting to access treatment and wait times might be somewhat long to get into specialized treatment?
Dr. Linsey Utzinger 28:26
Right? Unfortunately, right now that is happening. Families are having to wait long times; longer than any of us would like- us and them both. What I would say to families is that everything that we've talked about today, they can do. They can start to implement some of these things at home without waiting to see us. I would still encourage them to make appointments and have those on tap for down the road; But absolutely, they can start. There is no reason to wait to start to feed their kids.
Dr. Karen Nelson 28:55
What might be some of those tips that you would give parents as they were waiting to access specialized care for their child? What could they do at home in this moment as they're kind of preparing to get into treatment?
Dr. Linsey Utzinger 29:08
Sure. Um, I know it might feel like a lot to start to do this without the support of a team, but parents can absolutely start to make some of the changes... Like making sure their kids are getting three meals and three snacks, paying attention to you know, when their kids say they already ate and having parents be clued in enough now to say, "No, I didn't see it happen. Come sit with us at the table." Or just completely doing a 360 from where things are at now and implementing this and just saying, "You know what, we are just going to do this." I would strongly recommend that families do not wait to start any of this start to feed their kids, start to set boundaries and expectations. One of the things I sometimes talk to families about in terms of being able to do that is to think about a time when their child was younger and they needed to get their child to do something. Like maybe it was, you know, how did you get your 10-year-old to wear their helmet when they were riding a bike? You probably set some limits and some boundaries around that. Right? And you might have even said, "If I see you without your helmet one more time, I'm taking your bike away." And what did that do? Was that effective? Yes, you got your child to effectively put a helmet on. It's a lot like that, right? What kind of tools do you have in your arsenal to use to get these behaviors to happen whether your child likes it or not?
Dr. Karen Nelson 30:38
I think that aspect of acknowledging, again, that this may be hard, and with it being hard, doesn't mean that I should stop... It means that maybe I'm doing the right thing... that some of that resistance is exactly what the eating disorder is going to put up, and I'm going to keep pushing through.
Dr. Linsey Utzinger 30:54
Exactly. And we see that in children too, right? That in trying to get a toddler sleep trained, [laughs] right? They might react more strongly at the beginning. They might cry more, throw more tantrums... But as long as you are consistent and you follow through, your children will learn that this is the way. This is how things are going to go now. And so implementing that with food and meals and snacks. Works the same way. If parents kind of create this system and this set of boundaries that more or less forces their children to kind of not have any other choice but to eat. Parents can make that happen.
Dr. Karen Nelson 31:34
That's a really good point. Thank you so much for joining me today, Linsey . Thank you for having me. I really appreciated the opportunity, I think to spread some awareness about these, you know, illnesses to families and other listeners who maybe are out there wondering whether or not their children maybe have this and what to do. So thank you. [Instrumental piano music] 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