Katy: Donna, thank you so much for being here. I would love for you to tell listeners a bit more about yourself. Who are you, what do you do, give us that backstory and then we’ll go from there.

Donna: Thank you so much for having me. My name is Donna. I’m a survivor of anorexia nervosa. I’m a mother of four, and I had a child with an eating disorder. I’m also a clinician now, and a big advocate in the mental health space, I’ve worked in advocacy for about 20 years. I opened a program at the Medical University of South Carolina for eating disorders. I also sit on the board of a nonprofit called One Mind, which is focused on brain research for mental illness. It started primarily around schizophrenia, but we’re doing a lot of great work supporting new researchers and helping fund new ideas in mental health more broadly.

Katy: That’s absolutely incredible. When it comes to your own lived experience with an eating disorder, having a child with an eating disorder, and now specializing in that as a therapist, how do you think your personal experience has helped you in ways your clinical training didn’t?

Donna: It’s a good question. I went back to graduate school at 48, I’m 61 now. I did my clinical year in addiction, running a group with another therapist who was in recovery from alcohol, and it was interesting how much we were able to relate to patients just from lived experience. Especially in the eating disorder space, it’s such a complicated disease to understand. Parents come in and say, “Why don’t they just eat?” It’s so much deeper than that. Having been in that headspace myself, when I work with clients I get the incessant thoughts, the irrational talk, the monster in their head, the noise.

Fast forward to my son, ironic, because I have three boys and a daughter, and I always worried about my daughter. I wanted a strong, confident daughter, and I got that. But when my son, who’s now 27, was 14, a kid told him he had “man boobs.” He hadn’t gone through puberty yet, and that sent him into a downward spiral into full-blown anorexia. Thankfully I was his mom, because the pediatrician thought I was nuts and didn’t think he had a problem, even though he’d lost a lot of weight in a short amount of time. But early intervention and good treatment meant that he’s now a lawyer, a scratch golfer, top of his class, an intense kid, but with no eating disorder behaviors in the food space at all. I really believe in early intervention and proper care. That’s something I still see missing in this field, we’re not doing enough to educate the people who could catch these early warning signs.

Katy: Right, if you hadn’t had your own experience, you might not have realized what was going on with your son. Even being worried and taking him to the doctor, if the doctor says he’s fine, you probably wouldn’t have pushed further. It really shows how much more education we need, for the general public, for parents, for healthcare providers, around what actually gets dismissed, overlooked, normalized, or even encouraged, when it’s actually disordered.

Donna: For certain. My oldest is 30 and my youngest is 24, and they were obviously influenced by social media, but not at the level kids are now. I’m seeing the onset of these behaviors at a much earlier age. We used to say the average age of onset for eating disorders was 19 to 24, I’d bet we can knock that down to 14 now, or younger.

Katy: I totally agree, I got a call yesterday about an 11-year-old.

Donna: It’s terrifying. And then there’s what’s going on with GLP-1s right now, which is a really controversial thing in this field. They’re doing a lot of good for people, the physician I work with says her diabetic and cardiac patients are doing so well on them. That’s fantastic. But then there’s a subset where it goes too far, and I’m starting to see that in my own practice.

Katy: The manifestation of the dark side of it.

Donna: Yes.

Katy: For people listening who don’t think they or anyone they know has an eating disorder, though I’d challenge that most of us probably do know someone, even if we don’t realize it, how do you think our current culture and social media are impacting our relationships with food and our bodies?

Donna: I think it’s toxic, honestly. My daughter and I were looking at an Instagram post of Rihanna with her kids the other day, and I said, “Oh my god, those kids are so beautiful,” and my daughter said, “Mom, that’s all doctored.” Whether it’s AI or something else, I’m sure her kids are cute, but we’re getting a false sense of what “normal” looks like, kids, adults, all of us.

Katy: It reminds me of the old research on magazines, even when we intellectually knew a photo was airbrushed, it still had a negative impact on body image. I’m sure it’s the same with social media, if not worse.

Donna: The teenagers I work with feel like social outcasts if they’re not on social media, they argue they need it to stay relevant and stay in touch with friends. I think there has to be some regulation. Other countries are cutting off social media access for kids 16 and under, Australia has mandated it. Since social media became a fixture, we’ve seen disordered eating skyrocket, and then COVID doubled down on that. I don’t think we’re ever going to get rid of it, I’m guilty of being on it too much myself, so I think it’s about awareness, especially at a young age.

Katy: Do you have any best practices for using social media in a way that’s good for mental health rather than destructive?

Donna: As a parent, you’re in charge of what your kids have access to. I had a young client who went down the rabbit hole fairly innocently and ended up with anorexia, her algorithm just started feeding her eating disorder content, and she ended up teaching herself about anorexia. I think it comes down to less screen time, set start and stop times, phones off by a certain hour, and paying attention to what your kids are searching or what their algorithms are showing them.

Katy: Some of what’s out there is so disturbing, you can see how susceptible a young mind would be to getting hooked into that.

Donna: It really is parental oversight. With my college-age clients, I often encourage them to take a break from social media altogether if I see them struggling. One young woman I work with has actually gotten to the point where she recognizes it herself, she’ll say, “Will you hold me accountable? I’m going to take a break,” and I’m all for it. A lot of it just comes down to paying attention.

Katy: Noticing how it’s affecting you, or your kid, and setting boundaries. When we think about a healthy relationship with food and body, what does that actually look like, so we can start to recognize when something in our culture is actually healthy versus not?

Donna: Making sure you’re getting proteins, healthy fats, not over-exercising, that old 80/20 adage. I think the problem is we’ve labeled foods “good” or “bad,” when really there shouldn’t be bad foods. You should be able to have an ice cream cone or a slice of pizza. I always ask my clients: is your quality of life good? Can you go to a restaurant and order what you want? Can you go to a birthday party and have a piece of cake? That black-and-white thinking, “I’m never having sweets” or “I have to exercise seven days a week,” is what’s dangerous. I’m not sure I can define “normal,” but for me it comes down to quality of life: can you fully participate? I see clients who are afraid to eat the birthday cake or the pizza at a sleepover. All of that becomes normal again once it’s in proportion.

Katy: Can you go out, have fun, and not stress about it.

Donna: Exactly. If your quality of life is thriving and your relationship with food is a distant second, that’s great. If it’s flipped, we need to work on raising quality of life and lowering the food obsession.

Katy: A lot of people listening might think, “That’s not me,” but I hear over and over from people in my world that they spend a lot of time and mental energy thinking about food, calories, exercise, their body, their weight. Where’s the line between dieting, disordered eating, and an eating disorder?

Donna: It comes back to how much of your day is spent on those thoughts. There’s now a diagnosis in the DSM-5 called EDNOS, eating disorder not otherwise specified, for when you don’t meet full criteria for anorexia, bulimia, or binge eating disorder, but you still have disordered eating. It boils down to how much time in your day you’re focused on what you’re going to eat, when, how, where, and how you’re going to exercise. We’ve also learned from PET scans that the brain of someone with anorexia looks different from a “normal” brain, so there is a predisposition for some people. But honestly, as a woman, I think almost all of us have something we don’t like about our bodies. How many women do you know who are truly satisfied with their bodies?

Katy: The statistic I read recently was that around 90% of women have dieted at some point to try to change their body. And the older we get, it’s not just weight, it’s wrinkles, gray hair, any sign of aging. We’re never allowed to feel good enough.

Donna: Exactly. I’m one of five children, three girls, and I’m the only one who developed anorexia. My sisters were able to diet and get back on track without going down that dark path, so there’s a genetic piece. And my son, of all four of my kids, was the last one I would’ve expected to develop an eating disorder. So I don’t think we’re all predisposed to full-blown eating disorders. But societally, we are constantly looking at, judging, and trying to change our bodies. There are just a lot of rules. The tipping point is how much of your day that takes up. I have a friend who just doesn’t seem to carry any of that, she has a healthy balance with food, exercise, and fun, and I often wonder what that would even feel like, because I don’t know many people like that.

Katy: It’s refreshing to have friends like that, versus being surrounded by people who are always talking about dieting and exercise, it can be hard to find your way to a normal, balanced relationship with food and your body.

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Katy: This was such a powerful conversation. I want you to think about your own relationship with food and your body, how much time you spend thinking about what you ate earlier, what you’re going to eat later, whether it was “healthy enough,” whether you’re going to lose or gain weight. How much time you spend thinking about your appearance, your weight, how you’re dressed, your wrinkles, your hair, and whether you’ve exercised and burned enough calories today.

We should think about whether we’re taking good care of our bodies, but we don’t need to be thinking about it constantly. If this stuff is taking up a lot of space in your thoughts, that can be a sign of disordered eating or an eating disorder.

If you’re wondering whether this might be you, I highly recommend making an appointment with a therapist who specializes specifically in eating disorders, it’s a niche area of training and expertise, and they’re the ones who can do a thorough assessment and give you clarity. And even if you don’t have a clinically diagnosable eating disorder, there’s still real value in talking to a professional, because our culture has messed us up pretty badly around how we view food and our bodies. Most of us could stand to take a look at how we’re thinking about these things.

So what does a healthy relationship with food and your body actually look like? Here’s how I’d define it, not an exhaustive list, but enough for a bit of self-assessment:

With food:

• You think about food when you need to, when you’re hungry, planning meals, grocery shopping, cooking, or it’s time to eat, roughly 15–20% of your day. Outside of that, you’re not thinking about it much, because you don’t need to.
• You don’t assign moral judgments to food. Food is just food, no “good” or “bad,” and you don’t feel like a good or bad person based on what you eat.
• You can recognize when you’re hungry versus wanting to eat for other reasons, and you mostly address those other reasons directly rather than turning to food or to restricting.
• You have the flexibility to eat because you’re happy, sad, or celebrating, but for the most part, you eat when you’re hungry and say no when you’re not.
• You can tell when you’re comfortably full and stop, without needing to clean your plate or hit a specific calorie or point target, and you rarely end up feeling stuffed.
• You’re thoughtful about nutrition but flexible, and you know that no single meal or day needs to be perfectly balanced.

With your body:

• You accept the body you’re genetically meant to have at this phase of your life. You might wish you were thinner because of cultural messaging, but you’re not willing to fight against or betray your body to weigh less.
• You recognize your body changes as you age, and that’s normal.
• You move your body in ways that fit your life, your preferences, and your abilities, movement as self-care, not self-punishment.
• You address your health directly, without making it all about the number on the scale. Health is complex, shaped by many variables, and includes your mental and emotional wellbeing, and obsessing over weight and health can become unhealthy in itself.

As you read through all of that, how do you feel you’re doing? If you’re realizing you’ve got some issues in this area, that’s okay. It’s far more common than you’d think, because our society has fostered, encouraged, and normalized disordered thinking about food and bodies. Now that you’re aware of it, you have the opportunity to work on it head-on.

Reach out if you need support, we can talk through coaching options, or I can connect you with resources in your area. Donna’s website and contact information are linked in the show notes; she’s incredibly knowledgeable and well-connected in the mental health field, so reach out to her too if you want to learn more about her work.

And remember: you are enough already, just as you are. We’ll talk again soon.

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