What eating disorders do to the brain and body

0:01You're listening to Life Kit from NPR. Hey, it's Marielle. Today we're bringing you an episode about eating disorders from our friends over at Shortwave. Shortwave host Emily Kwong talks to pediatrician Eva Trujillo about how eating disorders can impact the body and brain, about the influence of diet culture, and about what recovery looks like. Here's the episode. Maria Friedman is truly one of the coolest 17-year-olds I've ever met. We started talking a year ago because she wanted advice on how to start a podcast. Hello and welcome to Balancing Act, a mental health and wellness and semi-unfiltered podcast.

0:47Our conversation, though, quickly turned to something else that happened to both of us. We both developed an eating disorder in middle school. Eating disorders among teenagers skyrocketed during the pandemic. Maria's began during the COVID lockdown. She was cut off from her peers and spending way more time watching TV. You see the protagonists and they're all like so beautiful. And you're like, do I have to look like that to be worthy, to be lovable? And Mireya, who was already struggling with perfectionism and anxiety, started to feel awful about herself. The world was spiraling out of control, and now my body was spiraling out of control.

1:31And so what did I try to do? I tried to control it. Eating disorders among teenagers skyrocketed during the pandemic. For Mireya, two servings of pasta became one serving of pasta became no pasta at all. She had intense exercise goals, all in an effort, in her mind, to become healthier. And it was only when we went to the doctor and they're like, no, this isn't healthy. Your heart isn't doing that well. You haven't had your period in months. Where it was like, oh, hey, that's not really healthy. Eating disorders are hard to put into words, but they are not choices. They are the neurobiological consequences of an illness that touches all areas of your life.

2:16Eating disorders literally rewire the brain. They are not just emotional or behavioral. Pediatrician Eva Trujillo is the president of the International Association of Eating Disorder Professionals. She's also the co-founder of Comenzar de Nuevo, a leading treatment facility in Latin America where patients from all ages and walks of life learn skills and find a way out. Recovery is possible, but the brain needs time, food, therapy, and compassion to heal. Today on the show, going it not alone with your eating disorder with pediatrician Eva Trujillo. We talk about how eating disorders affect the brain and the body and answer a question from Mireya about how to sustain recovery in a world steeped in diet culture.

3:08I'm Emily Kwong, and you're listening to Shortwave from NPR.

3:20Okay, so Dr. Trujillo, you worked with the Academy for Eating Disorders on a list called the nine truths about eating disorders. It's a great list. And one of those truths is about who has an eating disorder. Who does this affect? Yes, this is key. The stereotype of the thin, white, affluent teenage girl leaves thousands of people invisible and unfortunately undertreated, underdiagnosed. So eating disorders do not discriminate. They affect people across the entire spectrum of human identity, men and women, trans, non-binary people, children, adults, athletes, parents, immigrants, indigenous populations, people in larger bodies, and those in the smaller ones.

4:07We know that eating disorders are just as likely and often more likely to go undiagnosed in people from marginalized communities, including people of color, low-income individuals, and the LGBTQ population. Let's talk about the physical impacts more. And I want to move from the top down, from your head to your toes. How do eating disorders change your brain? So when someone is malnourished, when someone is not eating all the calories they need to eat, regardless of their weight, the brain is deprived of the energy it needs to function properly. There are studies that report that there's a reduction in what we call the gray and white matter of the brain.

4:59So that means the brain is literally shrinking and it would lose a lot of the biochemical compounds it has that can help you to determine your mood and the way you think and the way you feel and the way you perceive your environment. And how does that feel in the mind of the person who has an eating disorder? Cognitively, patients often experience difficulty concentrating, obsessive thoughts about food, rigid thinking, poor emotional regulation, and even symptoms that may resemble ADHD or depression. Or families say sometimes my daughter disappeared. It's like she's not herself anymore. And that's not an exaggeration.

5:51The brain is starving. Yeah. But the good thing, the good news is that many of these changes can be reversed with full nutritional rehabilitation. And, you know, thinking about the impacts, it's just so totalizing. You're saying it affects every part of the brain. Every. But, you know, that should come as no surprise because how cells work is they need nutrients to sustain energy. So what happens to the rest of your body over time if a person is malnourished through an eating disorder? Well, every organ can get affected. For example, malnutrition slows the metabolism and the heart response by becoming smaller, weaker.

6:32You know, the most important muscle we have in the body is the heart. So we can find bradycardia, which is a dangerously slow heart rate, and that can trigger sudden cardiac arrest even in young people who look healthy. Also, people can have a delayed gastric emptying or bloating or constipation or reflux. And these are not only from what's eaten, but from how the body adapts to a starvation or purging. And another area that can be affected is the bone density, which drops, putting even teenagers at risk of developing early osteoporosis or fractures. And, you know, going from the top to bottom, as you said, you know, the hair loss, the brittle nails, the dry skin are visible signs that something's wrong nutritionally.

7:36Yeah. Let's talk about recovery. I think a lot of eating disorders are first addressed within a family, right? Families notice, there's something not okay with my kid or with my cousin or with my sister. And families can be patients and providers' best allies in treatment. So how should someone approach a loved one if they're seeing some of these physical and behavioral and cognitive signs that you're describing? That is a very good question. I think that the most effective way is to approach in a very compassionate and nonjudgmental way. The people who suffer from an eating disorder are already suffering a lot.

8:21And if we don't validate that suffering, then we will make them feel so much shame and so much guilt that they will close themselves and they won't speak with us. And part of treatment also is creating an environment for healing. So Eva, you were a part of a consulting panel for TikTok and Meta, which owns Facebook and Instagram, on safety policies related to body image and eating disorders. Yes. And TikTok recently banned a hashtag called Skinny Talk, which aggregated a lot of extreme weight loss content, unrealistic depictions of people's bodies. And yet this content, it is still out there, right?

9:11Even in advertisements, even on television, whether you have social media or not. So I want to ask you a question that comes from Maria Friedman, a teen mental health advocate who's on the road to recovery herself. She wanted to know. what makes recovery sustainable, especially given all these outside influences and pressures from the internet, from diet culture in general, from the people around us? And how can we protect ourselves when these triggering images and words will inevitably appear because of the world that we live in? Very good question. First, recovery is not just about weight or food.

9:52It's about reclaiming life, identity, and connection. And in today's world, that includes our digital spaces. We do a lot of education to our patients, to our families, to be critical about the things they see, they listen, and to use all the strategies that they learn with us about comparison, about body image, being critical and not only critical, but, you know, one of the things that we know is that change the conversation and you can change your environment and that will change your life. And for example, here in Latin America, when the hashtag skinny talk came, we are part of the community channel.

10:45So we are a community partner. So we put our suggestions to ban that hashtag. We launched the first eating disorder helpline in Latin America that is directly embedded in our website and is also embedded in the app because recovery happens in real life, but digital life is part of that reality. That's why we must make platforms, you know, safer, smarter, and more compassionate for our people, for our patients. So it sounds like how you look at recovery that's sustainable is it has to go beyond the clinic. People surrounding the patient also need to be educated and on board. Yes. In general, medical doctors receive less than five hours in the whole career of eating disorder education.

11:36That's shocking because eating disorders have some of the highest mortality rates of any psychiatric disorders. That's exactly, exactly. But we still have countries, complete countries without either even one specialist in eating disorders. So we need to do a lot of things in education because it's one of the most powerful tools we have to fight eating disorders, not just in treatment, but in prevention and in advocacy. Because I always say it's not that I want to change the world. I just want to change the world of one person. Eva, thank you so much for talking to me. And thank you for everything you are doing for people out there who are struggling with eating disorders.

12:19No, thanks to you for your work. Because I think this is, it takes a village. We need everyone in this.

12:35And that includes patients like Maria. She's advocating for herself and other teens. imagining a future where she is free. I'm trying to really move forward, be like, how can I redefine what is empowering to me? How can I be whole without needing to micromanage every piece of myself? Because with eating disorders, it's never just about the food. It's never just about your body. it's all a manifestation of something that's so much more complex underneath but now I'm really trying to do the work to separate food and my body from those other feelings in my life so that I can learn how to stop sabotaging myself and to just try to learn to be me

13:37This episode was produced by Rachel Carlson and edited by Rebecca Ramirez. It was fact-checked by Tyler Jones. The audio engineer was Maggie Luthar. Beth Donovan is our senior director and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. Thank you for listening to Shortwave, the science podcast from NPR.

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