Dr. Sheldon Eakins: (00:00)
Welcome, Advocates, to another episode of the Leading Equity Podcast, a podcast that focuses on supporting educators with the tools and resources necessary to ensure equity at their school. Today. I've got a special guest with me, Dr. Kelli Rugless is here. So without further ado, Kelli, thank you so much for joining us.
Dr. Kelli Rugless: (00:18)
Of course, I'm glad to be here.
I'm glad you're here. You and I actually had a pre-chat, and I don't do a lot of pre-chats before we actually do our interviews. So I got a little chance to vet you if you will. And I was so excited to be able to just chat with you for like 10, 15 minutes. So I'm looking forward to our conversation, but before we get into it, I'd love for you to share a little bit about yourself and what you currently do.
Sure. So I am a licensed clinical psychologist. I'm based in Southern California, and I have a private practice. [The] private practice specializes in women's mental health in general, but it's women across the lifespan. So I have a lot of experience working in hospital settings, in academic settings, and working with adolescents and young adults and even school-aged children. One of my big areas of specialty is eating disorders and body image. So I've done a lot of family work with adolescents and young girls specifically around body image and the relationship with food.
Okay. So we're going to be talking about eating disorders. It's not something that I've covered on my show before. So I'm excited for that. And we're going to talk about how those eating disorders impact our academics of our students. And so let's jump right in. So what are some of the current trends with eating disorders among today's youth?
So I think your listeners and you as well might be surprised that the current trends with eating disorders have a lot to do with wellness and what you would just consider healthy eating. So what I'm seeing more than ever is young girls, young children, girls that haven't even gone through puberty talking about protein and carbohydrates and fasting and flat tummy teas and going on a sugar detox. So it's all of these things that are marketed to adults as ways to have a healthier lifestyle or avoid certain -- and I say air quotes around "unhealthy foods" -- but what I've found is that for young kids, especially adolescent girls who haven't yet gone through puberty, their bodies still have a lot of growing to do, this sort of black and white thinking around food really sets the foundation for disordered eating and eventually difficulty feeding their bodies in a healthy way.
So let me follow up with that because I'm thinking almost want to say what's wrong with our kids wanting to be healthy? Are they taking it too far? Tell me more.
Yeah, that's basically exactly what's happening. So there's really nothing wrong with our young people wanting to be healthy. And I think a lot of the reason why they are greatly influenced by this kind of information is because, you know, here in the United States, we have an obesity epidemic, right? So all of the health information that we receive is really geared towards people who are struggling with obesity, right? That does not include kids going through puberty. In fact, a sign of health for an adolescent is weight gain, right? If a kid's not gaining weight that lets us know as mental health professionals and other health professionals, that something might be wrong. So you have these kids who are normal body weight, but maybe they feel they're a little too chubby, or maybe they feel they've got a little bit of extra weight around their belly -- normal stuff, right?
Their body actually needs that nutrition to grow and to do the things that puberty needs them to do. So oftentimes with young kids, you're going to see that they expand outwards before they grow upwards. And it keeps sort of happening out than up, up until they get to about 18, 19. And even though they're not growing taller, their body still needs the nutrition to grow as they get older and what these diets do and what these little these detoxes do is they restrict really important food group from a body when it absolutely needs it most. So it actually defeats the purpose of trying to be healthy. And as young kids, they're just not able to make these kinds of decisions in a way that actually serves their body. It's usually more about aesthetic than it is about actual health.
Thank you for clarifying, because [when you] first started talking about it I was like, "Okay, she's got to tell me more because I don't know what this means." I'm not trained, I'm not a licensed professional in that sense. So, okay. That makes a lot of sense. Now when it comes to just regular exercise. So I would imagine that you're okay with the regular exercise. It's more of those trendy -- if you will -- "diets" that are out there that are more the challenge.
It's the trendy diets. And it's this idea that there are certain food groups that the body doesn't need, right? So the idea that carbohydrates are bad, carbohydrates are very, very important for the human body. And so really with everyone that I'm working with, the ultimate goal that I have for them is what we call intuitive eating, which is this idea that you think about a baby, a baby wakes up when it's hungry. It nurses, right? An infant, it nurses when it's full, it stops, it wakes up again. It's hungry. It nurses when it's full, it stops. Nobody really tries to micromanage what a baby does. And we see that babies grow beautifully when they have the right nutrition, right? When they have access to nutrition, babies grow beautifully. And it's purely because the body naturally is able to cue us with when we're hungry when we're full.
And if we actually listen to that, we don't have to be nearly as concerned about the fine details of what we're eating. And especially with young kids, what we don't want to happen is we don't want to disrupt the connection between their ability to listen when their body says it's hungry. So some of these diets and some of these detoxes, what they end up doing is they tell you don't have carbs, right? Do not eat them, not ever. And when even when the body wants it, even when they, the kid wants it, they develop this ability to say no to themselves and to prioritize some other goal over what their body wants. And that can sometimes be the foundation for an eating disorder. So the ultimate reason why we really want adolescents and young people to avoid these kinds of trendy things is we want to maintain their ability to listen to their body. We want to maintain their ability to recognize hunger and act on it and recognize fullness and act on that as well.
Got you. Okay. So let's shift gears. Knowing all of this, Kelli, how do these eating disorders impact a child's academic performance?
So they impact them in a really big way. If we just deal with, let's say anorexia nervosa, which is just one of several eating disorders within that sort of umbrella. If we just deal with that one alone, there's a lot of cognitive impairments that happen once anorexia nervosa really gets started. So anorexia nervosa just as a background is when an adolescent or an adult struggles to be able to maintain appropriate body weight because there's a sort of desire to be thin above all else. And so that means they have a hard time feeding themselves in a healthy way. They skip meals. And as a result, their bodies end up losing more weight than it needs to. And it struggles to survive. One of the symptoms of anorexia nervosa [is] cognitive impairment, meaning they struggle with concentration. They struggle to be flexible in their thinking. So everything is all or nothing. It's black and white. They start to have limited emotional expression, right? So the kids' aspect gets really flat, even when something's exciting, they don't seem to be able to be excited. If we think about social interactions at school, which are extremely important for an adolescent's development, they start to avoid social situations because oftentimes food is involved so slowly, but surely they can go from this bright kid who's social and engaged and involved to sort of a loner that no longer engages with people and struggles to maintain their grade point average.
So that's just one just anorexia. Now with like, say, for example, maybe bulimia are there similar characteristics there or are there different--?
Similar characteristics. But I would say it's probably not as like concentration difficulty is one with bulimia. For example, they experience more fatigue than anything else, which means they are too going to have difficulty concentrating, and they're going to have difficulty staying awake and staying focused in class. So they have a similar difficulty in terms of what they struggle with in school, but it's for different reasons, right? So for someone with anorexia, they're struggling with concentration because their brain isn't getting enough nutrition; for someone with bulimia, they're struggling with concentration because there's a lot of fatigue when you're constantly forcing yourself to vomit after meals. And that leads to electrolyte imbalances and can also lead to some other cognitive impairments, but it looks the same, but it's for different reasons. If that makes sense.
I'm with you. Okay. So, and you'll have to forgive me because I know two eating disorders and that's anorexia, and that's bulimia. That's the only two I know about. So are there some other ones that maybe we should be mindful of that we haven't talked about yet?
There's some other ones that are not quite as common, but one that I think is really important. So we talked about anorexia nervosa. We talked about bulimia nervosa. I really want to talk about atypical anorexia because atypical anorexia has all the symptoms of anorexia nervosa, except the person isn't significantly underweight. And I think this is really important because I think one of the myths about anorexia, in particular, is that you have to be really thin and you have to look a certain way in order for people to be open to the idea that you have an eating disorder, but atypical anorexia happens when someone is obese. Let's say someone is significantly overweight, but they decide to go about losing weight in a really unhealthy way. They go about it by starving. They go about it by engaging in overexercise, or they go about it by greatly, greatly restricting themselves.
They will have the exact same physical and health complications as someone who is underweight. And so that's another one that I think is really important to talk about. And there's another one called avoidant restrictive food intake disorder. And that's a fancy way of just saying someone who is very picky with their food and so picky that they struggle to feed themselves in a healthy way. So they aren't really worried about body image. They're not really worried about -- they don't compare their bodies to other people's bodies, but they really struggle with food texture or food color or things have to be in a certain brand. Think about a child who might also be diagnosed with autism spectrum disorder. Oftentimes these two things can come together. So that's another one that I think is important. There's a few others, but they don't happen very -- they don't occur as --
Okay, so I'm in the clear then because they're not as frequent. So, okay. So the next question that I have, and we're going to shift gears just a little bit and get a little bit more specific if you will when we're talking about eating disorders, how -- cause you and I talked prior to this us talking right now on the phone, and you were sharing with me some of the disorders -- eating disorders -- when it comes across race and ethnicities. Could you share a little bit about that for us? Just kind of how maybe some of those disorders are different amongst race?
Sure. So I think this is again another really important topic because I think eating disorders have been historically thought to only happen in upper class -- middle class, upper-class white girls, right. That has been [the] stereotype of where eating disorders exist and that everybody else is protected because you know, black people and Latinx people, we have a more open cultural perspective towards body shape, right? We are more open and accepting of a curvier figure. And so we don't struggle with those things, but the reality is not true at all. So every single ethnic group outside of the Caucasian group experiences eating disorders, and the rates aren't really significantly different between races. And what I will say is that black teenagers, for example, are actually 50% more likely to exhibit the symptoms of bulimia than white teenagers are. So it's actually a bigger problem in the black community than you would imagine.
And Hispanics are more likely to suffer from bulimia than their non-Hispanic peers. So there's something that's happening in communities of color that's unique. Something else to know is that in the American Indian and Native American population, American Indian women are just as likely as white women to have an eating disorder, which honestly is very concerning because it's really well documented that there's a lot of underutilization of mental health care among native people. So the idea that they are experiencing eating disorders at the same rate as Caucasian people, but not getting nearly as much mental support is really concerning because it means it's rampant. And it means it's impacting not just one generation of girls, but generations to come because it could be normalized. It could mean that a lot of this disorder eating behavior has become normalized in a lot of communities of color. And so it's just not getting addressed. So overall, it's impacting everyone. It's impacting communities of color in unique ways and sometimes even more intensely than it's impacting white communities. And another thing is just, even though it's not ethnicity-based, teenage girls from low-income families are like 153% more likely to be bulimic than girls from wealthy families. And while low income doesn't necessarily mean communities of color. If you look at income disparities, it's usually communities of color that have lower income. So we are being impacted by this, but we're not getting treatment.
I got a question.
So you said 153% of students that are coming from lower socioeconomic status now.
Tell me more about that. Because I was initially thinking for bulimia at least, you know, that means that you're eating a lot and then you're vomiting it. I would think that someone from maybe a lower -- maybe I'm stereotyping, so correct me if I'm wrong -- but I would just think that if someone that is coming from a lower socioeconomic status, food insecurity might be related in some of those instances. So eating more -- it's throwing me off. So could you tell me a little bit more about that?
Absolutely. Food insecurity is actually at the heart of the bulimic cycle, right? So with bulimia, what's happening is you have a person who is eating a certain amount of food, and then they're feeling an extreme amount of guilt for the food that they've eaten. And now they are vomiting the food up as way of sort of relieving the guilt, maybe getting rid of some of those extra calories, but it's to sort of make them feel better and get rid of the guilt that they have for eating as much as they've been eating. Usually, that means there's been a binge eating episode, which means -- oh, we didn't talk about that one. Binge eating disorder is another big eating disorder. But what that means is, let's say that you come from an environment that is food insecure, right? So that means that there's a lot of moments when you're not getting enough food, right?
That means you might skip breakfast, or you might skip lunch. And so by the time you get to dinner, you are so unbelievably hungry that you eat in a way that makes you uncomfortable. You eat to the point that you're beyond full because you've skipped breakfast, you skipped lunch, you didn't have money to get a snack. You didn't have money to get XYZ. The cupboards are empty. And so let's say what you did have was Cheetos and maybe a slice of pizza or something else. And you feel out of control, right? Now, you've had this food in your mind, you think it's really unhealthy. You think it's really bad for you, and you can't believe that you ate that much food in such a short period of time. You feel so guilty that you purge it up, right? So it's actually the deprivation binge cycle that I think really is why communities of color are experiencing this.
It may not be for the same reasons, right? They may not be vomiting because they have a weight goal. They might be vomiting because they're so ashamed of having eaten such a large amount of food in a short period of time, not realizing that was naturally their body's response to being starved all day, right? It was reasonable for them to eat that much because their body was missing out on a lot of calories. And so when it finally got the opportunity to eat, it's sort of even more than what they would normally eat and to eat to a point where they feel uncomfortable.
Does that make sense?
That makes a lot of sense. And I'm glad you shared that because my initial thought was like, "Well, if they don't have a lot, you know, food insecurity as an issue," but then I see how you're saying like, "Okay, maybe they don't know when their next meal is. And then so they go hard when they get that food, and they feel bad, or they feel stuffed, and now they're purging that." Okay. So, that makes sense. Now you did say that you wanted to touch on binge disorders. So I wanted to give you a chance to jump on to that.
Sure, though, they're another really important eating disorder that really does impact communities of color more than others is binge eating disorder, which has to do with eating a large amount of food in a really short period of time and feeling out of control, feeling like you can't stop, even when you want to. And binge-eating again, I think, you know, when we think about food insecurity, it really does fall in line with that kind of environment, because it's a part of what happens to the body. It's a natural response to not getting enough nutrition. If you have to skip breakfast, if you have to skip lunch, if you aren't able to get enough nutrition, when you do have food, there's gonna come a point in time when your body just craves more calories. And so once you have access to it, it might be really hard to stop eating because your body is trying to prepare you for the next time that you don't have food. So binge eating disorder is another really big eating disorder that occurs in communities of color.
Okay. Thank you for sharing. Now, I'm sure that there's some myths out there, cause I know I'm not the only person that like, I'm just loving this. This is so much gold for me because I'm like, I didn't know all this stuff. So what are some myths out there that are associated with eating disorders?
There's so many, I think the main ones are that it's mainly female. It is not. There's plenty of research to show that men engage in disordered eating behaviors, just as much as women do. But again, I think some of it's normalized. For example, when you think about bodybuilding, right? Nobody thinks eating disorder, you think, "Oh, you know, someone who's dedicated to fitness and dedicated to bulking up and things like that." But oftentimes, bodybuilders exhibit some of the exact same restrictive behaviors that someone with anorexia nervosa exhibit in a very similar way, but bodybuilding isn't categorized. And it doesn't fall under the criteria of an eating disorder, but it's been shown like kind of a new area in research of, you know, I think there might be just as much disordered eating in the male world as it is in the female world. So this idea that it's mainly female is a myth, this idea that it's only white people is a myth, that it's only wealthy people, that you have to look a certain way in order to have one, right? That you have to be either extremely obese or you have to be very underweight. There are plenty of people that are normal body weight that are struggling in very significant ways with eating disorders, but it goes undiagnosed by providers. It goes missed by family members, and it's mainly because of their appearance.
Okay. So let's touch on that because, like, how would I recognize this? Like if I'm an educator from a school counselor, whoever, whatever position I have as an adult, and I'm a mandatory reporter, and I want to keep my kids safe, what are some signs that we should pay attention to? And how should we respond if we suspect that a child has an eating disorder?
That's a really great question. So I think some of the signs might be a little shocking and a little surprising, but what I'll do is I'll talk to you a little bit about the profile of someone who might be struggling with an eating disorder. Because I think as educators, I have seen so many of my own clients in my own practice have come to me because an educator highlighted that something was wrong because an educator told the parents, "I've been noticing this, I think something's wrong. You should get your daughter evaluated." So perfectionism is actually something that, as educators, you guys probably come in contact with all the time, right? A student that even after you clearly explained what the homework is, they come up and ask you again. And they double-check, is that my homework assignment? Is there anything else? Or you see them re-erasing and rewriting something that was already perfectly done, spending way more time on homework than they need to spend going above and beyond as an educator that might feel like, "Wow, that's great.
The student really dedicated," but perfectionism can sometimes be a really good foundation for an eating disorder. Because part of how an eating disorder thrives is with really black and white thinking, is all or nothing thinking, and being able to push yourself beyond your limits. So if you have a kid that's perfectionistic, that's one sign to say, "Okay, well, let me just keep my eye out." If you notice a student is withdrawing from social groups, particularly at mealtimes, right? So at lunchtime, if you notice a student is no longer eating lunch anymore, and you notice that they avoid birthday parties or they avoid any class function where there's a potluck, that's a sign that something's up, especially if they used to participate. No problem. If you notice increased exercise, [I] say exercise, I just mean you notice that they're getting up and walking around for no reason, or they're always bouncing their leg, or they have to go to the bathroom several times, and you don't really think they have to go to the bathroom, or you catch them making laps during lunchtime.
That's a sign that they might be over-exercising right. They might be feeling like they need to do everything they can to burn calories. If you ever notice anybody calorie counting or reading a bunch of labels and turning things over and looking at everything before they eat it, these are all signs that maybe something's up. I think the easiest way to know is to be able to have something to compare it to. So if this is a student that you've never met before, it might be a little challenging, but if you happen to have been around to see the change, that's the best way to kind of get a sense of the fact that something might be wrong. And honestly, the best thing that you can do is involve a school counselor and talk to the parent, let them know what you're seeing, encourage them to get evaluated by a mental health professional, and sort of be their eyes and ears when the parents aren't at school.
I have so many thoughts on this. As I was listening to the, I guess, the symptoms or signs, if you will, [of a] potential eating disorder. And I just thought about like biases that we might have as educators and how [the] perfectionism part was the one that really stuck out to me -- we teachers tend to love those students that want to strive to do the best and get perfect. Like, so now I'm hearing that that could possibly be a red flag. So I'm torn because -- you gotta help me out here because I don't want us to misdiagnose and our biases to kick in. Is there like -- put yourself in the educator's shoes. If you were teaching, if you were in a classroom, you had a student that was -- you considered them a perfectionist, and you noticed some changes in their behavior around lunchtime and all that kind of stuff. What kind of process maybe would you take? And I know this is a very broad question and no situation to pin, but just kind of step us through that.
Sure. I totally understand how this could be really hard because oftentimes, the kiddos I'm seeing are amazing individuals. They are high achieving, they've got great grades. They are doing everything. They're doing the sport, they're doing the school, they're doing the volunteering. I mean, these are kids that seem extremely motivated and extremely focused, right? So as an educator, what I would encourage an educator to look for is kind of look at the whole child, right? Perfectionism is valuable for academic achievement, but it can make social relationships challenging, right? Applying that same kind of mentality to humans, you're going to struggle because you can't guarantee that a human is going to respond the way you want to respond if you do this certain thing, right? So if I was an educator and I saw a student who was my straight-A, golden student, who did everything, worked really hard.
And I noticed that she started to withdraw a little bit or he wasn't eating lunch anymore. I think the first thing I would do is I would wait. See if I notice a pattern, is it just one day where they're skipping lunch, or is it two, three days? Has it become their norm? Once I started to see that it became the norm, I might just ask them like, "Hey, what's going on? I noticed you're not eating lunch anymore. What's up?" And I might just ask and see and just feel them out and see what they say. Do they say, "Oh, I'm just trying to get healthy" or, "Oh, I'm just not hungry anymore." What's going on, right? I want to hear what's happening. And if the answer is one of those, that's a pretty common answer. "I'm not hungry. I'm just not hungry at lunch."
I would respond by saying, "Well, really, that's so odd because you know, the body really needs to eat. Like it needs food. That's so strange that you're not hungry anymore. When did that start?" Right? I'd want to just have a conversation. And if you start to feel like this doesn't feel right, like these answers aren't really making sense to me. Then I would cautiously let the parents know what you're seeing. I wouldn't necessarily say, you know, "Hey, I think your kid has an eating disorder," but I would say, "I've noticed some changes in your child. I've noticed they're not eating lunch. And I asked her about it, and she said she's not hungry. And that just seems really odd because she's here so long and they get here at eight o'clock in the morning. She should be hungry by lunchtime. So I just wanted to let you know," right?
Even that can be really helpful for parents to get some insight that something might be off and to continue the conversation with their child. Because oftentimes, when I'm with families, what I find out is that the first place that it started was at school. They started skipping lunch, and their parents never knew. And things got out of hand after that, right? Then they started work. They found ways to restrict dinner. They found ways to restrict breakfast, but it usually starts with lunch. So just being able to let a parent know that you're noticing that difference could be really valuable for them to be able to follow up on it.
Okay. Okay. So we are recording this during a pandemic.
And a lot of our students are at home online or doing packets. However, the schools have structured education. Do you have any research, or have you seen any research on eating disorders during COVID-19? Maybe it's too early to tell. Do you have maybe some suggestions on teachers that are facilitating online classes that maybe do Zooms or Hangouts with their students? Maybe some things that they might want to look out for as they're doing, you know, proceeding in their classes?
You know, I don't think I've actually seen any data on eating disorders during the pandemic outside of like how to still provide effective interventions for people who are going through recovery. What I will say is that there ha[s] been discussion about whether or not this idea that a lot of kids receive lunch through the school system. And so kids who are no longer in school could be missing out on more food, which means we could see a rise in things like binge eating disorder and bulimia, and some of the ones that have a role in sort of that deprivation binge cycle, there might be sort of a rebound effect of an increase in those disorders. I haven't seen any research come out on specific things to look out for teachers. I think it would be really challenging honestly, for educators, because part of how eating disorders thrive is they thrive in secrecy. They thrive in hiding behaviors. And I think a Zoom classroom would make it even harder for a teacher to be able to get a sense of what's going on. And I know a lot of Zoom classes don't allow kids to eat during those classes. So again, that would make it a challenging thing. So I don't know if I have any honest feedback for how a teacher might intervene or what to look for on Zoom because I think it would be really challenging.
Okay. Yeah. And I know a lot of teachers ask students not to eat during their sessions, or students aren't required to show their videos. And so that could make it a challenge. But I think maybe when we reach out to our families, our students, and just checking in on them, maybe that could be one of the questions that we ask, "How are you doing? As far as food goes, are you eating regularly? Have you been snacking? Are you getting your fruits and veggies?" You could have maybe those kinds of conversations when we're talking to our families, even in an email or a postcard or something. I don't know. However, we're communicating. I think that might be an option.
I agree. I think just talking about it is important. Cause I think it oftentimes just goes -- it just doesn't get on people's radar. And especially during the Zoom meetings, I'm seeing a lot of clients who are in the Zoom classes all day. And what I'm finding is that their schedule has really disrupted their eating schedule. They're skipping breakfast because they're getting up five minutes before the Zoom class has started, skipping lunch because they're finishing assignment here and there. So I absolutely think that a conversation about, "Are you making sure you're getting up early enough to eat breakfast? Are you still getting regular meals throughout the day?" could be really helpful for educators to have with families just to remind them that even during these uncertain times, structure, especially around nutrition, can be really helpful for kids.
Okay. Thank you. So Kelli, you know, I definitely consider you as providing a voice in leading equity. What is one final word of advice that you can provide to our listeners?
I think the biggest piece of advice that I would give people who don't have any experience with this and are hearing about it for the first time is just that it's okay to get help. And it's okay to be dealing with these kinds of issues. There is no shame in struggling with mental health in any way. There is no difference between a mental health issue and a physical issue, just like people get colds, and you go to the doctor, and you find out what you need to do. Mental health is really the same way. And so I would encourage anybody who is questioning this, number one, do some research, look it up, ask questions. And as an educator, if you see someone and you're not sure don't be afraid to ask questions, don't be afraid to dig in there and find out how you might be able to help. And to families and parents who are listening, don't be afraid to seek help. And there are mental health providers out there who are [inaudible] and ready to help you and your family sort of recover from whatever mental issues you're dealing with. And so I think that's my biggest thing. Be willing to ask questions and be willing to get help.
Okay. Be willing to get help. And that could be hard. You got me a little nervous now as an educator with the perfectionism part. So it might be a little difficult, but I appreciate you sharing that with us. So if we have some folks that want to reach out and want to connect with you online, what's the best way?
The best way is I have a website it's www.drkellirugless.com. I have a contact page there that you can reach me at. And I have an Instagram account, same @dr.kellirugless is the handle, and you can message me on there as well if you have any questions. I get lots of questions all the time about this. "Does my child have one? This is what I'm seeing. What do you think?" And I'm happy to have a conversation with anyone about what an eating disorder looks like and how to get help.
Well, once again, I have Dr. Kelli Rugless with us today. Thank you so much, Kelli. It has truly been a pleasure.
Thank you for having me.
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