Podcast Transcript

Renfrew Conference Mini-Series Episode 8: Exploring Emerging Trends and Hot Topic Research in the Field of EDs

[Bouncy theme music plays.]

INTRO

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

INTRODUCTION TO THE EPISODE

Ashley: Riddle me this. What is a place where people gather, but not to hear musical clatter, where hundreds of helpers roam the halls, but no one is making emergency calls? A place where wellness and recovery are discussed, but most importantly, a place where no one’s voice is ever hushed. If you haven’t figured it out yet, I am of course talking about The Renfrew Center Conference and in this episode, Sam and I sat down with Sandra Wartski, psychologist, and certified eating disorder specialist to get a little competitive and test our knowledge during her game of Wait Wait Don’t Tell Me: Exploring Emerging Trends and Hot Topic Research in the eating disorder field. We hope you enjoy this fruitful, fast, and very fun conversation.

EPISODE

Ashley: All right, welcome back everyone. Ashley and Sam here, and we are joined by Sandra Wartski, PsyD, CEDS. She’s a licensed psychologist who has been a part of a group practice in Raleigh, North Carolina for the past 30 years. Dr. Wartski specializes in the treatment of eating disorders, affective disorders, and trauma. She also enjoys providing educational workshops to the public and professionals on a variety of mental health topics. So, thank you so much for joining us today.

Sandra: You are very welcome. I’m happy to be here.

Ashley: Yeah. I have to tell you, I was telling Sam before this, so I couldn’t make it to your workshop yesterday because we were recording the podcast. But I really, really wanted to because the moment I saw the title of your workshop, wait, I want to read it correctly, Wait Wait Don’t Tell Me: Exploring Emerging Trends and Hot Topic Research. I immediately got excited because in December of 2020, I was on Wait Wait Don’t Tell Me. (laughter)

Sandra: That is fabulous.

Ashley: So, I saw this, and I thought I have to meet you.

Sandra: Wow.

Ashley: I want to hear the genius behind how you created a fun and also informative workshop.

Sandra: Okay. And I would also maybe like to hear behind the scenes. It would have been great if you’d come because it would have been interesting to see like what could I tweak and improve?

Ashley: And I probably would have gotten a little competitive, too.

Sandra: Some people did.

Sam: I’m sure.

Sandra: So, the idea came from, so as some listeners may know, on NPR, there’s a Saturday afternoon, there’s a Wait Wait Don’t Tell Me, whereas I see it, it’s kind of an overview of news stories from the week. And it’s a fun-hearted, light-hearted way, I think, listeners to learn a little bit about what’s going on and they do it usually there’s famous people or comedians and so it’s funny, but it’s an overview. And I was listening one Saturday to it as I was driving somewhere and I thought, gosh, I really would love for us as clinicians in this field of eating disorders to have something like this where we got to have an overview. And I was like, oh, bummer, bummer. And I’m like, oh, I guess I could try to create one. So that’s kind of where that came from. And then it just kind of took off. And I really appreciate that Renfrew was willing to, you know, I kind of pitched this idea to them and they were willing to say, okay, let’s try it. So yeah.

Sam: It sounds so fun. Like what a fun way to get your continuing education credits. Who says it doesn’t have to be fun?

Sandra: Right. Yeah, right. Exactly. So that’s where that came from. So, and also really just at the bottom of it is that the fact that we… at clinicians in any field, but I think especially in a specialty field like eating disorders, there really is so much to learn. The field is continually changing. Right. And so it’s this juxtaposition of like, there’s so much we have to know, yet we can only do so much. Our work is really hard. And so was trying to kind of come together to like, how can, like, let’s talk about that. Let’s talk about the learning process, but also let’s make it fun and just highlight a few things. Obviously, I don’t expect that anybody walked away with, hopefully some new facts, but I don’t expect that necessarily people would be, it’s not going to be a 180 degree change necessarily, but I think it’s important anyway to know some things in different areas. That makes it part of what some of the participants said to me. They said, gosh, I never thought of research as being potentially interesting and kind of fun. They’re like, I like the idea of, okay, how can I apply that to my clinical work? And that to me was so important. That’s great. That was so important to hear that because yes, we need to do that more, I think.

Ashley: I feel like our field had been begging for evolution for some time and change and like and approaching the things that maybe, you know, traditionally didn’t want to approach or we didn’t want to talk about and so I love that you brought current trends, that you brought some research, that you gave us something to think about. So, I’m just curious could you touch on some of those topics or some of those current pieces of research that you did bring to the workshop yesterday?

Sandra: Sure. Would you like me to do it in a format where you guys try to guess? Would that be fun?

Ashley: Maybe.

Sam: Let’s do it.

Ashley: That sounds rather fun.

Sandra: Okay, so how I broke it down into six different categories. So, eating disorders in general, the body, co-occurring, diversity, intervention, and prevention. And so, we did six to 10 questions in each of those areas. So, what I could do is maybe pick a couple from maybe, or maybe one from each of those areas if you want or something like that.

Sam: Yeah, let’s do it.

Ashley: That sounds so fun.

Sandra: Okay. Excellent. All right. So, one of the, for example, in the ED disorder in general, I talked about that there’s a, NEDA and EDC often give grants for researchers who are doing good work and one of the recent grants was given to somebody who’s working in DOD, Department of Defense, about talking about a new program for identifying eating disorder in veterans. And the question is, what would you guess is the increase of eating disorders in the military in the past five to ten years?

Ashley: You want a percentage?

Sandra: Yes, give me a percentage. And as I said to my people who attended, I don’t expect you to know the exact, but ballpark it because that engages your thinking.

Sam: Sure. Well, whatever it is, it’s probably an underestimate, but I will say that. Let’s see. What do you think, Ashley?

Ashley: I want to say 40%.

Sandra: Okay.

Sam: Increase?

Ashley: Yeah. Only because I do feel like we’re discussing it more.

Sam: And it’s getting caught. Yes. I’m not as optimistic. I’m not. Yes. I’m going to say, I actually think maybe 25% increase. I just, I’m not sure it’s actually getting caught as frequently as it should. Yeah.

Sandra: All right, well, I’m going to give you a little ding, ding. Ashley, it’s about 44%. Whoa! Which is yay on the answer, but also how sad, right?

Sam: Yeah, I was just clapping, but now I’m… No, I know, the reality is hitting me.

Sandra: Yeah. No, but your point is great too though, Sam, because this idea that like, what is not being caught. Yeah. And the fact that probably what that means is it doesn’t probably, I mean, we don’t know, right. But that probably does not mean that 10 years ago they weren’t there. It means they were not being caught. So great on being caught. Right. But the fact that, oh, my goodness. And so that’s an example of one that’s just kind of interesting tidbit of information. Right. All right, you guys ready to try another one? Okay. Yeah. Okay. All right. Let’s see. What was a public place this summer where people were being asked to step on scales?

Ashley: Oh, oh, a public place.

Sandra: And it’s okay if you don’t know.

Ashley: My guess is gonna be like the Today Show or something, like the Good Morning America or something like that.

Sam: Oh, that’s a really good guess. I’m not sure.

Sandra: Okay, well, the answer I’m going to ding (bell sound) it because the answer is Air New Zealand this summer was asking anybody who was flying to step on a scale. And they weren’t announcing the weights or anything like that. But it was this idea that we need to know more about not only what the luggage weighs, but what do our passengers weigh coming on. And, and of course, it’s an interesting controversy. And so, in our answer section, we talked to, you know, a little bit about the fact that like, some people thought this was terrible and other people were like, well, are we making more of weight? And, you know, again, in the eating disorder field, it’s a very such a mixed bag. And then also, you know, talked a little bit about in looking at that, that now there’s some effort to say, okay, should we actually be looking more at upper arm circumference instead of weights? So, there’s some research behind that, that that’s actually less shaming, than doing the weights or the measuring. And I hadn’t heard of that except that a colleague of mine was studying for one of her SEEDS exams and apparently that’s being referenced. More of the pinch method. Yeah, so anyway, it’s interesting, right? To just think about. So, for example.

Ashley: I do remember that now that you’ve talked about that.

Sam: Yes. It is ringing a bell.

Sam: I remember reading about it. Right, right.

Sandra: So. And that’s actually, you know, some of the questions are just kind of fun and silly, but they’re a way to talk about something else. Right. You know what I mean? So not that it really matters that much about that Air New Zealand was doing this, but let’s as clinicians talk about what does this mean and when to weigh and not to weigh and what measures do we use, right, to work with our clients.

Ashley: Well, and what does that create anything in a, you know, for anyone, if you hear that, like what is… (inaudible)

Sandra: Exactly. Shall we keep going? All right, let’s see. Okay, let’s move on to co-occurring issues, which of course most of us know that eating disorders never travel alone. So, it’s very common to have co-occurring issues. But in this section of our game show we talked about the less frequently talked about ones. So obviously depression and anxiety are high co-occurring issues, but we talked about different things like body dysmorphic disorder and ADHD, and also substance use disorder. So, here’s a question from the substance use area. So, in eating disorder population, what would you guess are the percentage of individuals over 18 that have substance use disorders? And as I told my participants, anything within 10%, we’re going to call right.

Sam: So, these are folks with eating disorders? Oh, okay. Okay, I’m going to say 45%.

Ashley: You are, see, and I was thinking a little bit lower this time. I was thinking somewhere between 25 and 30%.

Sandra: Okay. Okay, well actually Sam’s a little bit higher. 66%. Wow. Is kind of the, right, which is scary.

Ashley: Yes, that is.

Sandra: And I don’t consider myself a substance use expert, but I have learned that I’ve had to become more skilled in that area because when you start to dig in more and more, people, when we ask them about it, it’s actually a co-occurring issue. So yeah, it’s scary to look at this. And just also to think about like, what is similar between eating disorder and substance use treatment and what is the difference? And of course there’s both. Yeah. So that’s interesting to talk about.

Ashley: Yeah. It’s also making me think as a clinical like when we do those initial assessments, like what are we asking, but what are we not asking?

Sam: We should be screening. That’s a high number. Yes, yes. It’s so important to screen.

Sandra: And this was one study and I’m not sure. Actually, it’s multiple studies that support it, but and I think people have different, how do you address it? What do you consider and as part of the substance and alcohol is the most popular among our eating disorder clients, which I think is not surprising to a lot of people. But yes, it’s scary. We have to probably assess more.

Sam: Oh, yeah. It makes me so happy to know that we do have a substance use program at Renfrew. So that’s a good thing.

Sandra: Excellent. And it is so great, I think, right when it’s not. And I think it used to be even 10 or 20 years ago, it used to be that people would say, substance use first and then eating disorder treatment or vice versa. But really it needs to be something. So, it’s a great point. Okay, from diversity, let’s see. For our LGBTQ youth that have eating disorders, if they have one accepting adult in their life, they are less likely to attempt suicide. And again, it’s another percent question. Would you, I’m going to give you a multiple choice. So, would you think they are 10% less likely to attempt suicide, 20%, 30% or 40% if they have one accepting adult in their life?

Sam: I’m staying with the 40%.

Ashley: I’m going to say 4o% too.

Sandra: You guys both got that right.

Sam: I know how powerful that is when you have someone else.

Ashley: Community and that sense of support, that is a protective factor. I talk about that in our talks. You know, whenever we do talks, like, it is so imperative.

Sandra: Exactly.

Sam: Lifesaving.

Sandra: Exactly. That’s right. And that sometimes the clinicians are the one protective adult. Right. So ideally, we’d like for it to be. multiple people, and ideally, I think the whole community would be great. But also that we have the power as clinicians to be that person that could really be powerful for somebody who’s really struggling. So great. You guys are doing really, you’re definitely getting the two out of three, right? Yeah. Okay. This a couple of months ago in the International Journal of Eating Disorders, there was a title of an article that started with, But the Reality is That it’s Happening. What were they talking about? If you didn’t read the article, can you guess?

Ashley: The reality is that…

Sam: That what is happening?

Ashley: Right. What is happening? That our body image is so much more present and aware because of social media.

Sam: That’s a good guess.

Sandra: That’s a good guess. Do you want to guess too, Sam?

Sam: That children and adolescents are dieting.

Ashley: Oh, I kind of even want to say that children are getting bariatric surgery.

Sandra: Oh, that’s also, yes, that’s also a problem.

Sam: That could be too.

Sandra: Okay. Those are both excellent points. But what the article was actually about was about psychedelic assisted therapy. And how it is coming.

Ashley: It is coming.

Sam: Yes.

Sandra: Like it or not, ready or not. Yeah. And I think a lot of clinicians, right, this is a newer field, kind of like the AI and all of that. Right. And so, I shared a little bit about some really impressive research of really much quicker recovery responses with some of the psychedelics. So, again, even though clinicians I think have probably some mixed feelings about that, but it ready or not here it comes.

Ashley/Sam: Yes. Well, we actually just released an episode on psychedelics and eating disorders. And so, and actually we have a couple of episodes on the podcast too about psychedelic assisted psychotherapy.

Sandra: Well, you are ahead of the curve.

Sam: We like to think so.

Ashley: Okay, Sandra, we might have time for one more.

Sam: I think one more.

Sandra: One more, I was going to say, because our last category is prevention. Okay. Let’s see, I’m going to try to pick one that’s interesting. Okay, two thirds of people with eating disorders show what kind of disorder several years before their eating disorder emerged.

Sam: I’m going to go with anxiety or depression. I’ll stick with anxiety.

Ashley: I kind of want to say something with attachment, but not quite reactive attachment. Do enlighten us.

Sandra: You got that right, Sam. Anxiety. I mean, it’s interesting to know that, right. That anxiety disorder is that can be a precursor and not that every anxiety obviously turns into an eating disorder, but that if we are seeing some of those precursors, can we be a part more of the prevention? And I think any clinician who’s worked long enough in the field wants to do more of the prevention, right. Because we’re seeing like, oh my goodness, so many people coming and being so you know, just so ill.

Sam: Absolutely.

Sandra: So, you know, at the end of all of the quiz show, part of how we came together by the end was just to say, you know, there is a lot to learn. There’s a lot we, you know, are going to have to continue as a state of perpetual learning and perpetual, kind of like with the GPS talk, like continually recalculating, right? Like how, where do we go and how do we go? But that we also have to be at the end of the day, we are also just clinicians that are doing the best we can. We have to be human beings that we are connecting and that’s also super important to our clients, of course, that we are just in relationship with people and it’s not all about the facts, right. And to go from there and to just be kind and compassionate with yourself about the process of being a lifelong learner, right.

Sam: Exactly. It’s a journey.

Sandra: Yeah.

Sam: Yes, it is a destination.

Sandra: That’s right. That’s right. That’s right.

Ashley: So actually, I feel like that has been a theme throughout this conference this year, is that it is a lifelong journey. And yes, some of the material that we have presently will be shifting and we know that it will be shifting and it’s okay to embrace that.

Sandra: Yes, yes, yes. Exactly.

Ashley: Sandra, thank you so much.

Sandra: You’re welcome. Thank you for playing along. Yes, I know I put you a little on a little spot. Thank you.

Sam/Ashley: Thank you.

OUTRO

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

[Bouncy theme music plays.]