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HAES and Eating Disorder Treatment

by Dr Lauren Muhlheim, F.E.A.S.T. Advisory Panel Member

In this post we are sharing a recent The Full Bloom podcast episode that featured an interview with Dr. Muhlheim, by permission of the podcasters, at the invitation of F.E.A.S.T. Executive Director, Laura Collins Lyster-Mensh. The Full Bloom Project podcast is a “weekly dose of body-positive parenting wisdom.”

We asked Muhlheim to introduce the topic:

If you know me, you know that I am a strong proponent of two things: Family Based Treatment (FBT) and Health at Every Size ® (HAES). I know that parents do not cause eating disorders and can be critical allies in recovery. I also believe a weight-inclusive approach—acceptance that bodies come in all sizes—is crucial for recovery. I believe that adapting a HAES approach to health can help reduce the harm that comes from eating disorders and perhaps even prevent some eating disorders.

I am not sure that all eating disorders can be prevented. Or that eating disorders can be prevented by parents. I have a lot of empathy for parents who fear their child being considered “too big” or teased about their size. I believe that parents mean well and only want the best for their children. But parents are unfortunately brought up in the same diet culture as their kids, are subject to its messages, and are often given bad advice by well-meaning professionals, including doctors and teachers.

Even when parents do all the right things in their parenting to avoid triggering eating disorders, their kids can still develop eating disorders. Why? Because eating disorders are complicated illnesses that stem not from a single cause but from a complex interaction of genetic and environmental factors. Children don’t live in a bubble created by their parents and the world around them continues to send messages that their bodies are inadequate and that they need to do or purchase things to make their bodies better. Numerous societal messages encourage dieting, and dieting triggers an energy deficit, which in those genetically predisposed can develop into an eating disorder. Even when there is no intention to diet, eating disorders can be triggered by unintentional weight loss or a negative energy imbalance following surgery, an illness, or intense sports.

If we can lessen the likelihood of a child ever dieting, we might prevent or lessen the chances of tripping the energy deficit switch. If I were to make a recommendation for a parenting practice that could help protect against some of the pressures of diet culture, I would suggest two things:

  • A non-diet approach that includes allowing kids to eat intuitively (Ellyn Satter’s work) and does not categorize foods into good or bad groups.
  • Role-modeling acceptance of all body types, neither pathologizing people in higher bodies nor expressing preference for thinner bodies.

But even more important for prevention is to monitor your child’s growth curve to make sure your child continues to grow and gain along their own unique genetically predetermined blueprint. Pediatricians these days are given so many messages about preventing obesity that they may miss the earlier signs of an eating disorder. Yes! Hard to believe. But it happened with one of my children with a trusted pediatrician. In this podcast episode, I discuss this and more.

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