Eating Recovery Academy Podcast Kate Fisch

Show Notes
 
What role is Social Media playing a role in causing eating disorders or disordered eating?
Are the effects of Social Media making treatment of eating disorders more challenging? 
In this podcast episode, Kate Fisch speaks with Dr. Samantha DeCaro about Social Media. She discusses the effects that Social Media has on patients recovering from eating disorders and the role it plays in causing disordered eating.
 
MEET DR. SAMANTHA DECARO
Dr. Samantha DeCaro, PsyD is the Director of Clinical Outreach and Education for The Renfrew Center, a licensed psychologist in Pennsylvania, and co-host of the podcast All Bodies, All Foods. She has been with Renfrew since 2012, completing her post-doctoral residency at The Renfrew Center Philadelphia – Spring Lane, then holding the position of Primary Therapist, and most recently serving as Assistant Clinical Director. 
As Renfrew’s national spokesperson, Dr. DeCaro has been featured in the media as an eating disorder expert on various television shows, radio programs, podcasts, and online magazines. She is a frequent lecturer and serves as the Alumni Representative for The Renfrew Center of Philadelphia.
Visit The Renfrew Center to find out more.
  IN THIS PODCAST The focus on Social Media
What are Pro-Ana and Pro-Mia sites?.
What risk factors do Social Media pose for eating disorders?
What makes eating disorder recovery so challenging?.
 
Why did you choose to focus on Social Media and eating disorders? “I do a lot of trainings and education in my role and I realized that Social Media was really having a negative impact on people who were trying to recover from eating disorders.”
Dr. Samantha DeCaro
 
Are you on Social Media? “I'm on social media myself. I knew that it was causing certain issues for me as well. I noticed I wasn't feeling great after I was done scrolling. I was realizing I was spending more time on it than I wanted to be.”
Dr. Samantha DeCaro
 
It is interesting that even professionals within the field can be affected by Social Media and it puts an emphasis on making sure we are aware if it is leaving us in a more negative space.
 
“Absolutely, I am in no way Immune to the effects of social media. I think it impacts all of us and I wanted to learn more about it.”
Dr. Samantha DeCaro
 
What are Pro-Ana and Pro-Mia sites? “I remember earlier in my career learning about Pro-ana Pro-mia, which were essentially these sites, and it's exactly what it sounds like, pro anorexia, pro eating disorder type content.”
Dr. Samantha DeCaro
 
There are so many different apps out there that we may know very little about and thinking of it from the perspective of being a treatment provider, it is vital that we become familiar with all the different platforms that our clients may be exposed to or using.
 
“I remember being so concerned and horrified about the things that were happening on those sites and now with social media. Yes, I think those things still exist, to an extent, but I think that the harm is a lot more insidious. It's a lot harder to catch the different toxic messages about food, about the body.”
Dr. Samantha DeCaro
 
Do we need to learn to be more mindful when using Social Media? “What I do in my trainings, I try to help Clinicians help their clients be more mindful on social media. How to help your client tap into what they're experiencing while they're scrolling. You might be strengthening that eating disorder without even realizing it. ”
Dr. Samantha DeCaro
 
That's interesting because it's almost like we teach our clients how to be mindful at the table  or how to be mindful in their relationships, how to be mindful even just right in the moment.. But this is a kind of Meta  in the way that it's like another virtual environment in which they have to be mindful in.
 
“ Oftentimes scrolling is an act of distraction. I think that's another thing to be aware of: when a

Show Notes
What is Bariatric Surgery? What is Bariatric Counseling?
Is there a link between Bariatric Surgery and eating disorders? 
In this podcast episode, Kate Fisch speaks with Sharon Ryan about Bariatric Surgery. She discusses the challenges that patients face when preparing for, or after undergoing, Bariatric Surgery.
 
MEET SHARON RYAN
Sharon Lynn Ryan, MEd, AABC, LAC,  is a licensed associate counselor, therapist, speaker, and writer.  Sharon earned her masters degree in professional counseling (MEd) from William Paterson University, board certification as a bariatric counselor/educator from the American Association of Bariatric Counselors, certificates in personal training and nutrition from the National Personal Training Institute, and is clinically trained in EMDR, DBT, and CBT.
Sharon specializes in eating and weight disorders, bariatrics, health and wellness, and is a firm believer in Health At Every Size (HAES)  intuitive eating, and body positivity.
Visit Sharon Lyn Ryan to find out more.
  IN THIS PODCAST What is a Bariatric Counsellor?
What are the common feelings for patients, post bariatric surgery?.
Is there a link between bariatric surgery and eating disorders?
Post Surgical Eating Avoidance Disorder.
 
What does it mean to be a board certified Bariatric Counselor?  
“There's an association called the American Association of Bariatric Counselors. You get board certified as a counselor so that you can work specifically with Bariatric patients. They require all the CEUs that you would get as a counselor or a therapist every two years you're reassessed and do your CEUs but it gives you specific training to work with people who are struggling with weight and maybe attempting to have bariatric surgery  ”
Sharon Ryan
 
When we speak about patients who have undergone bariatric surgery, it is easy to assume that all the patients are happy with their results. This is not always the case and there are individuals who are frustrated that they don't look the way that they want to look or that it didn't go as promised.
 
“The American Association of Bariatric Counselors also covers the complications that come along with it and the problems that may come before and after, and how to address them so they cover not only the nutrition part of it, but the psychological part of it. Which is something that's really been overlooked, I feel like. in the field.”
Sharon Ryan
 
Why should patients go for counseling before having bariatric surgery?  
“I think there needs to be actual counseling and therapy for people prior to the surgery, because the people who are going for Bariatric surgery have, at the very least, disordered eating .”
Sharon Ryan
 
Is there a possible link between eating disorders and getting bariatric surgery?  
“From 2011 to 2019 there were about 2 000 000 bariatric surgeries performed in the United States. A study found out that 66% of them had a lifetime history of some sort of eating disorder and 48% of them at the time of them being approved for surgery had criteria for binge eating disorder.”
Sharon Ryan
 
It makes us wonder how many of those that are willing to have the surgery actually knew they had an eating disorder. 
 
 How do you prepare patients for Bariatric Surgery?  
“They need to be educated prior to their surgery. They need to go through therapy prior to their surgery. They need to be with a Dietician prior to their surgery. Not just once. And figure out why they're eating the way they're eating, why they're at that weight.”
Sharon Ryan
 
It becomes important, when encountered with a client considering this surgery, to take the time to understand why they are considering the surgery, why they feel they need the surgery and build that relationship with the client.
 
“ The first rule to me of being a therapist is to be non-judgmental. So, if someone walked in and said I'm thinking of Bariatric surger

Show Notes
What is the approach to treating eating disorders in athletes? Are the pressures of having to perform as an athlete increasing the chances of developing an eating disorder? 
In this podcast episode, Kate Fisch speaks with Linda Steinhardt about eating disorders amongst athletes. She discusses the effects that measuring body composition, the pressure to perform and injuries have on athletes and developing eating disorders.
MEET LINDA STEINHARDT
Linda Steinhardt is a registered dietitian based in Denver, Colorado. After graduating from the University of Texas at Austin, she completed a sports nutrition fellowship at UNC Chapel Hill. She now works at the Athlete EDGE Program within EDCare, an eating disorder treatment center where she supports athletes and general population patients in lasting recovery from eating disorders.
Visit Athlete Edge to find out more.
  IN THIS PODCAST What is body composition testing?
Is there still a necessity for measuring body composition in athletes?.
What is the approach for treating eating disorders in athletes?
Is there pressure for athletes to perfect their performance at a younger age?
 
What is body composition testing? “Body composition testing is really common, to be honest, in college athletics. I have seen, with body composition testing in colleges, they'll test an athlete 2 to 4 times per year and they'll say: hey here's your muscle percentage, here's your fat percentage.”
Linda Steinhardt
 
So what is the benefit of athletes knowing their body fat percentage etc. ? “I'm not sure I'm going to be able to help connect the dots. I think there's a lot of reasons why sports physicians in college settings are pressured, in a sense, to do body composition tests.”
Linda Steinhardt
 
It is interesting to think that there might be a belief that knowing your fat percentage (for example) and all of that could help with the goal of improving athletic performance.
 
Are we moving away (at all) from this type of measuring? “I had seen some more openness and some more curiosity in the field just of why do we do this and is this affecting athletes and is this actually helpful for performance. Are we just doing it because we think we're (quote,unquote) supposed to? And I think that has been a good shift.”
Linda Steinhardt
 
How is the approach to treating an eating disorder in an athlete different to treating someone with an eating disorder who is not an athlete? “So, I think there is a lot of overlap and I think there's some additional kind of barriers that athletes might face that put them at a higher risk of potentially developing an eating disorder. Often times we look at things like athletes are in really high pressure environments.”
Linda Steinhardt
 
How do you manage the conversation around calories? “I find, more often than not, food and exercise have become kind of compensatory, even perhaps without athletes recognizing it as such. I think it's helpful to acknowledge that: hey what are the ways in which you notice yourself eating the same or different on rest days? Do you feel better about eating when you play well, or do you find it harder to eat when you have a bad game?”
Linda Steinhardt
 
 When our diet and exercise culture has done us such an immense disservice that it's going to take decades to undo, which is simplifying humans' need for fuel.
 
Do a lot of athletes seem to lose the ability to listen to their bodies? “That's a conversation we have often. A lot of times people come in and they are really disconnected from their bodies in terms of they don't know, because the way they have been eating is from rules. Over time we can build that kind of intuition and that interoceptive awareness.”
Linda Steinhardt
 
Is there pressure for athletes to perfect their performance at a younger age? “I think that oftentimes a really big component of things is identity. In athletics often people start from

Show Notes
 
What is virtual care and how can it be used in treating patients with eating disorders?
What are the limitations or advantages of using virtual care in treating eating disorder patients?
In this podcast episode, Kate Fisch speaks with Dr. Erin Knopf about virtual care for Eating Disorders. She discusses the benefits and challenges around virtual care and the role it plays in assisting our clients and developing more effective treatments.
 
MEET DR. ERIN KNOPF
Dr. Knopf is dedicated to treating patients with eating disorders holistically. As a triple-boarded physician (pediatrician, adult psychiatrist, child/adolescent psychiatrist) and Certified Eating Disorder Specialist, she uses her combined training with intentionality to assess disease severity and devise comprehensive plans to address the eating disorder behaviors as well as comorbid symptoms of anxiety, depression, OCD, trauma and more. She describes herself as the “mechanic of the body” and prioritizes psychoeducation and biological education for patients and families to foster insight and achieve treatment alignment. Dr. Knopf previously worked in an IP/RES/PHP program for almost 5 years and at the onset of the COVID-19 Pandemic, she served as unit psychiatrist for ten months at the ACUTE Center for Eating Disorders. She is a member of IAEDP, AED, AACAP, APA and AAP.
Visit Virtual Eating Recovery For You to find out more.
  IN THIS PODCAST Will virtual care replace physical consultations?
The challenges faced with treating eating disorders.
Childhood obesity, diets and restrictive eating.
Lab results and eating disorders.
 
Do you feel like delivering care virtually gets in the way of connecting with patients? “I will admit, as an extrovert, I don't think there will ever be a way to replace the beauty of in person connection. There are nuances that are missed. But ultimately, would I turn away from virtual care? Absolutely not!”
Dr. Erin Knopf
 
When we think about virtual care, the cons might be pretty clear, but the pros just far outweigh, especially when we're talking about someone getting care versus not. . .
 
“It’s an opportunity to bring care to people who would never have it, it's flexible, convenient. So I think overall, the virtual care frontier is really exciting and we can only do it better with our technological advances.”
Dr. Erin Knopf
 
What is a big challenge you are currently faced with? “Right now we are, unfortunately, private pay, which I know limits access, but that is not our end game. We are currently working on credentialing with three insurance companies.We offer discounted bundles for services. We do super bills, and we even have a single case agreement.”
Dr. Erin Knopf
 
Eating disorders don't discriminate based on socioeconomic status. They also don't discriminate based on geographic location. It is important for all patients to have access to some level of professional care and help.
 
What are your thoughts on the American Academy of Pediatrics’recently issued a statement on childhood obesity? “The first part is it's still relying on BMI as the measure of obesity. It actually doesn't include in the definition any other medical considerations that people get worried about - type two diabetes, hypertension, hyperlipidemia, things like that.”
Dr. Erin Knopf
 
The steps that follow such a statement are extremely drastic, especially when we consider its referral to children. . .
 
“ It just says if a child's body is 90th percentile for age match, BMI percentage, then they meet criteria for obesity and therefore should be considered for, drum roll, either weight loss surgery, like bariatric surgery, or weight loss medications.”
Dr. Erin Knopf
 
What are your thoughts on why diets and restrictive eating are so common? “Human beings like diet culture because it helps them feel in control and powerful and capable of incredible discipline. Think

What is interoceptive awareness and can it play a role in the development of eating disorders?
What is interoceptive exposure and how can it be used in the treatment of eating disorders?
In this podcast episode, Kate Fisch speaks with Dr. Melanie Smith about interoceptive exposure and awareness. She discusses how interoceptive exposure can help assist our clients and develop more effective treatments.
MEET DR. MELANIE SMITH
Melanie Smith, PhD, LMHC, CEDS-S, is the Director of Training for The Renfrew Center. In this role, she provides ongoing training, supervision and consultation to clinicians across disciplines for the purpose of continually assessing and improving competence in the treatment of eating disorders. Dr. Smith is co-author of The Renfrew Unified Treatment for Eating Disorders and Comorbidity Therapist Guide and Workbook (Oxford University Press), is a Certified Eating Disorders Specialist and Approved Supervisor, and is a Certified Therapist & Trainer for the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP). 
Visit Melanie Smith to find out more.
  IN THIS PODCAST What is interoception?
What is interoceptive awareness?
How can we use interoceptive exposure to help clients?
The brain and body image.
 
Where do we start in terms of interoception? “Let’s start with interoception in and of itself. This is just our body’s internal perception, so our bodily senses of what is happening inside our body.”
Dr. Melanie Smith
Our clients are always looking for as many tools as they can to treat their eating disorder clients. It is important for us, as therapists, to understand all the factors that can influence eating disorders…
“When we think about eating disorder application; our ability to sense if I'm hungry, if I'm full, if my stomach doesn't feel good; all of that is what we're talking about when we're talking about interoception.”
Dr. Melanie Smith
 
What then is interoceptive awareness? “Interoceptive awareness is the level to which we are consciously aware of the things happening inside our bodies.”
Dr. Melanie Smith
 
It is important to understand what level of interoceptive awareness a client has and how they react to what is happening inside the body, because most of us, most of the time, shouldn’t be (or aren’t) noticing things such as our heart beating or ourselves breathing.
“Heightened levels of interoceptive awareness also results in heightened anxiety about what is happening inside our body. So we might start to overthink it or overinterpret what it means.”
Dr. Melanie Smith
 
How can we use interoceptive exposure to help clients?  
“The ultimate goal with interoceptive exposure is to intentionally evoke those same unpleasant, uncomfortable sensations. So, we're going to allow ourselves to experience that emotion, allow it to rise, BUT allow it to fall and learn that this is actually something we can tolerate.”
Dr. Melanie Smith
 
Interoceptive exposure seems to align with other methods and skills that we already understand as therapists or clinicians. If we were to think about Mentalizing, Acceptance and Commitment Therapy or Dialectic Behavioral Therapy.
“Those same principles are absolutely at work here, which is why I would suggest it as a wonderful adjunctive that could nicely coincide with any of those treatment approaches.”
Dr. Melanie Smith
 
When was this developed and is there any current research into the method?  
“The first places you'll see it in the literature as a proposed intervention, from an experimental standpoint, was back in the late 80s, maybe early 90s. But I think in the 80s specifically, it was proposed as a Cognitive behavioral exposure-based intervention for panic disorders.”
“There's also a lot of really interesting evidence out there and people doing more trials with this with individuals with PTSD because when you think about trauma response and the

Consisting of 5 new episodes, season 2 of the Eating Recovery Academy Podcast is about to drop!
Click here to listen to the official Trailer
 
From the second week of November 2023 the episodes will become available. The guests are amazing in their fields and we cover some fascinating and insightful topics surrounding eating disorder treatments.
Be on the lookout for the first episode - you won't want to miss it!
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