00:03:59.780And so, I mean, Erin, do you want to just like give us sort of an overview of this issue and like what people should know about it as like a little encapsulation?
00:04:08.660Well, I think one of the things that we run into when we talk about eating disorders is that we have this kind of preconceived notion of who are the people with eating disorders.
00:04:17.840And if I were to ask you, like, OK, picture somebody with an eating disorder right now in your mind, you would probably be thinking of a young adolescent cis female.
00:04:30.820You'd probably picture her being pretty thin and you'd probably have maybe some sociocultural dialogue about her not wanting to eat or being afraid of certain foods, maybe running a lot at a gym on a treadmill.
00:04:44.120Yeah. And this isn't to say that young cisgender females who are thin don't get eating disorders. They absolutely do. But I guess it is to say that the picture is a lot bigger than what we paint. You know, we see people who are very young starting to restrict, but we also have it in middle aged folks and aging folks as well.1.00
00:05:05.380in addition to different races, socioeconomic classes, and then body size. And then I've
00:05:12.260definitely, you know, gender, sexual orientation. Yeah, I have the disease of queerness and also
00:05:17.700the disease of fatness. Also the disease of meaning. Sort of look at that. Nailed it.
00:05:23.200To me, as someone who's obsessed with things that are true, but do not receive very much
00:05:27.540media coverage. I mean, the most shocking thing to me about your work is just the sort of the
00:05:32.520headline finding that it appears that the vast majority of people with eating disorders are fat0.55
00:05:38.620people. Yeah. My area of specialty looks at anorexia and atypical anorexia. And literally
00:05:44.880the difference between the two is a weight. They have the exact same kind of manifestation in terms
00:05:51.260of behaviors and physical consequences and psychological consequences and what folks are
00:05:55.940actually doing and thinking and feeling. But whether or not somebody gets one diagnosis or
00:06:01.860the other is defined based on BMI. Are there other implications of the difference between
00:06:06.720typical and atypical? Like, does it affect your ability to get insurance reimbursement and stuff?
00:06:11.600So atypical is considered a different category of eating disorder from anorexia. It's basically the
00:06:17.620other category of like, something's going on with you, but you're not quite textbook in any
00:06:22.080particular way. Oh, so it's like not real anorexia is like how the medical field considers it. Yes.
00:06:29.480It's a different code in the ICD-10 and in our DSM, it's a different code.
00:06:35.620And that significantly impacts people's abilities to get care.
00:06:39.560Super interesting as you're talking about all of this, that it really feels like quite a bit of the ceiling for how we understand eating disorders and who we can recognize them in is really sort of set by, you know, our own existing biases about fatness and fat people,
00:06:57.800but also about like a wide range of communities, right?
00:07:00.500Like part of the reason that we don't like see and think about eating disorders in people of color,
00:07:05.500I would imagine is that there's like zero representation of what that looks like
00:07:09.680or eating disorders in people who are living below the poverty line or what have you, right?
00:07:14.200Absolutely. For other eating disorders like bulimia and binge eating disorder,
00:07:19.880they're supposed to be behaviorally defined where we're looking at frequency
00:07:25.320an occurrence of binging and purging and compensatory behaviors. But what I'm finding
00:07:32.080and what people are reporting to me in my research is that clinicians seem to be more in tune to how
00:07:37.800a person is physically presenting when they're delivering some of those diagnoses. So I have
00:07:43.320people in my study that never, ever qualified for a diagnosis of binge eating disorder,
00:07:48.320but were given that diagnosis. And I would say it's likely because they were fat.
00:07:53.120Because the doctor's like, well, you must be binge eating, basically.
00:11:00.760I think it was about 1,600 calories, so somewhere between 1,500 and 1,600, which is not even
00:11:06.860a particularly low caloric benchmark by today's standards when we hear about some of these crash
00:11:14.100diets that people are doing. I mean, I've, I've heard people that are given recommendations for
00:11:19.600a 1200 calorie a day diet. And you know, one, one person tried to cut off his finger because
00:11:26.160he experienced so much psychosis in that experiment. People became obsessed with food.
00:11:32.440they read recipes all the time. They started developing some of the eating behaviors that
00:11:37.780we see in folks with eating disorders, like cutting their food up into small pieces and
00:11:42.040trying to eat over a long period of time to make it last longer. And then we also saw the physical
00:11:47.700consequences and then how long people were messed up because of that one instance of starvation in
00:11:54.460their lives. But what that study shows me is that like a, the effects of starvation are extreme,
00:12:00.700no matter how they play out just in a physical sense, you know, and something that Jennifer
00:12:08.200Gaudiani points out in her book is that starving bodies look and respond differently. And so you
00:12:13.740can see some people that get sick very quickly and they get emaciated very quickly. And some of
00:12:19.400that also has to do with how large their bodies are before they start restricting. You know,
00:12:24.760if you have somebody who's already relatively thin and they start restricting and they lose
00:12:29.720a certain percentage of their body weight, it can become clear pretty quickly that they are
00:12:34.900reaching a, quote, unhealthy place in their weight loss. If you take someone in a fat body,
00:12:40.920I mean, they could lose half their body weight before people even think that it's at all a
00:12:47.400concern. And for the most of that time, people are going to be congratulating them.
00:12:50.760Yeah. So that sort of that image of eating disorders that we have, what you're saying
00:12:55.260is that it's the minority of people who are in a starvation state who are going to look like that.
00:13:00.640I would say that based on what I'm seeing, that would be true. But I don't know if we have quite0.98
00:13:06.720enough research. Most of the research that we have on people who are starving, we already set
00:13:13.660a BMI component for them to be in the study. So we'll say that in order for people to qualify for
00:13:19.360this study on anorexia, they need to have a BMI below 18.5 or 17.5, depending on what we're
00:13:26.420specifically looking for and what time period in history. But what I would say from what we
00:13:30.980know about behaviors in terms of how fat people with eating disorders also eat is that there is
00:13:37.400a large percentage of folks that are restricting who are in larger bodies. I think that's what we
00:13:43.080do know because we've never really captured just everybody who's restricting or engaging in
00:13:48.400self-starvation practices. I mean, I've interviewed people who are like 250 pounds and severely
00:13:54.420restricting their diet and aren't getting their period. Yes. Which is just like a huge red flag
00:13:59.860for like your body is in crisis. Yes. In the study that I did, which had a range of BMIs for
00:14:07.180people presenting, it had kind of down to, you know, just above a normal, all the way up to a
00:14:12.420BMI of around 60, I think that we're presenting with things like orthostasis, which is when
00:14:18.420your body stops regulating its blood pressure in response to like changes in altitude.
00:14:23.780Like if you sit down and then stand up, we are seeing higher rates of orthostasis where
00:14:29.100bodies are like, they're not able to adjust to make those adjustments.
00:14:32.400So when these people walk up stairs, climb a ladder, stand up, people can fall and lose
00:14:38.660consciousness because their body, that basic homeostasis function of like regulating your
00:14:45.240blood pressure to move is not happening. So you're basically saying that there are fat
00:14:51.360people in a starvation state. Yes. And that there are people who are like right now hospitalized
00:14:57.520for starvation. Like they are there because they are medically unstable and unable to be in the
00:15:04.700public and they are in what we call, quote, obese bodies. I mean, you know, one of the things that's
00:15:10.520become more common colloquially is for somebody to talk about, you know, keto or intermittent
00:15:15.260fasting or these various fad diets. And then somebody will sort of jump into their replies
00:15:19.860and be like, actually, what you're describing is an eating disorder. And so how do we sort of
00:15:24.060draw the line between people going on a diet for, you know, whatever it's New Year's and like
00:15:29.340actually disordered worrying behavior? That's the question of the century.
00:15:33.000Right. I was hoping you could solve this. I'm sure there's no divergent opinions on this. I'm sure it's not an open debate among scholars at all. So just solve it for us, please.
00:15:40.060What I'm about to say is 100% correct and undebated.
00:16:00.940And I'll say like, OK, like if this is you and then if this other hand is like your thoughts about food and your thoughts about exercise and any kind of planning that goes into a binge or a purge or anything like that or what you're thinking about your butt and how big it is, your body and how much you want to change it and the plans that you have.
00:16:19.880And like how much of those do those two circles overlap?
00:16:23.700For many people with eating disorders, those circles are right on top of each other.
00:16:29.160Maybe there's just kind of like a sliver of stuff that they are thinking about or devoting
00:16:34.040time and energy to that's not related to their body, food or exercise, you know, but like
00:16:39.600if you're like, okay, well, if I think about this 10% of my day, am I okay with that?
00:16:45.000I also wonder if because there's so much gray area, that that's one of the reasons
00:16:49.960why we rely on weight so much, because it's like if somebody's weight is low or somebody's
00:16:54.840lost x percent of their body weight in x weeks then it just gives us a way to see that there's
00:17:00.120the signs of this but the problem is that then once we only rely on weight then we miss like
00:17:06.020the majority of people who have eating disorders and aren't under 110 pounds or whatever yeah one
00:17:11.960of the biggest predictors of weight gain is kind of this repeated weight cycling like repeated
00:17:16.100attempts to try and lose weight so that the longer a person tries to lose weight often instead of
00:17:21.400like a steady decline in their weight which would be maybe what they were picturing might happen
00:17:25.980what we see is a steady incline in a person's weight which then often reinforces that cycle
00:17:31.680for trying to lose weight right because they're at a higher place one thing i would say with that
00:17:35.940kind of relying on weight is we often miss people who have had disorders for long periods of time
00:17:42.040because often when you are restricting and engaging in starvation the first times that you are doing
00:17:48.280that. Your first weight loss attempts tend to be times when you experience greater weight loss
00:17:54.640faster. With more repeated attempts, it's almost as if the body kind of buffers itself. It kind of
00:18:01.840is like, oh, well, we're going into starvation mode again, and maybe it doesn't take as long.
00:18:06.300And so it kind of defends that set point of it that it's at a little bit more rigorously. And
00:18:13.460And so you might see, we might catch people in their first attempts at losing weight.
00:18:18.560We might catch the eating disorder faster than for people who have been doing this for quite a while.
00:18:23.280And maybe their bodies have just gotten used to, you know, people in my study there, you know, there is a person who, like her body was just really used to surviving on very, very little food.
00:18:34.840And, you know, and by the time that she made it to my study and got a diagnosis and started treatment, she was in a larger body and her body had just adapted and she was working overnight, staying up most of the time during the day, going to school and, you know, surviving on, I'm not even going to mention the amount that she's surviving on because I think it would have been, it would be too triggering for listeners.
00:18:55.300But it's really remarkable how we can miss people for such long periods of time because
00:19:23.520So if you really were having fewer calories in and more calories out, you would look different.
00:19:29.120We really have been sort of conditioned to recognize this one thing.
00:19:32.180And when that's combined with all of the stuff that we think we know about dieting and weight loss, which is like overwhelmingly just totally wrong, that that creates this, you know, sort of huge gap for people who sort of fall outside of that image to sort of fall into that gap.
00:19:48.000right? And sort of misdiagnosis, mistreatment, miss all of this stuff that they pretty deeply
00:19:54.040need. Absolutely. I think one of the things that makes you a good researcher on this and a good
00:19:58.380clinician is that a lot of this is like what you've been through yourself. Do you mind if we
00:20:03.560kind of walk through your own story and how you got interested in this? Sure. Yeah. So I definitely
00:20:10.100grew up in one of those white households in the nineties, snack wells, rice cakes and lots of0.71
00:20:22.480concern over like fat. And, you know, I mean, even down to things like in a really gendered way where0.80
00:20:29.100like, you know, the 2% milk was my dad's milk and the nonfat milk was my mom's milk. I could
00:20:34.340kind of take those messages that I got that I received about like fatness being bad or fat
00:20:40.240being bad in general. And the way that I interpreted those messages was that fat was
00:20:44.320always bad. I kind of took those messages with a child's mind and just took everything to this
00:20:50.200extreme point. And so, you know, I mean, I can remember doing like exercises as a five-year-old.
00:20:57.740This is something that I have to do and just feeling very driven in that.
00:21:01.660I can imagine the exact sweatpants you were wearing.
00:21:25.140I remember getting this like student of the week picture back and I was in third grade.
00:21:30.040So I was like eight years old and like, I was wearing like this one piece turquoise and magenta.
00:21:36.640It was really eighties, nineties where like a two-tone top and I was growing out my bangs.
00:21:43.660So they were like smack dab in the middle of my head, like a fountain.
00:21:47.680I remember like getting this photo and like, I refused to take it home to my mom.
00:21:53.680And I, I like hit it because I was so embarrassed at how my body looked looking at this photo.
00:21:59.200now, like, cause I, I have it and like, I I'm just a normal eight year old kid from the kind
00:22:06.280of that age. I started really paying a lot more attention to what I was eating, cutting more and
00:22:11.040more things out of my diet, you know, skipping breakfast, skipping lunch, you know, the, the
00:22:16.000types of things of how an eating disorder develops side by side being an athlete and on cross country
00:22:23.560and volleyball and basketball and like doing all the sports and then kind of like not really
00:22:29.320surviving and fueling my body much for it, but also feeling like, okay, I don't need that. Like
00:22:35.140I can live without it. And if I can live without it, then it's not a need. It's a want. Right.
00:22:40.840By the time I reached, you know, 15 years old, my friends had like a little intervention with
00:22:47.080my parents and we're like, dude, you know, Aaron's not okay. From that moment, you know, my parents
00:22:54.480took me to my doctor. My doctor diagnosed me with anorexia. Also, my family was low income. We had
00:23:00.160no insurance. There wasn't really a way to treat it. You know, my parents took me to a few
00:23:06.300nutritionists. I saw a counselor for a while, but I just kept getting worse. And I did end up in one
00:23:13.560of those bodies like you see in the daytime television looking pretty scary and medically
00:23:20.400unstable you know it was uncertain if I was gonna like survive my adolescence or not you know and
00:23:27.300because I never got treatment I would get like a little bit better but all those behaviors were
00:23:32.340still going on like my mom would give me insure and I'm like watering it down so you just like
00:23:38.680muddled through basically like keeping these behaviors but hiding them essentially pretty
00:23:42.900much yeah yeah like i'm still amazed that i like passed high school and college you know i mean
00:23:49.720like because it took up so much of my time i'm just waiting for the part of your story where
00:23:55.740you tell us that you finally got treatment because someone tweeted at you like what you're describing0.98
00:24:00.200as an eating disorder clap back it's our responsibility to shit on people on twitter0.97
00:24:07.380yes so when I got to college I did gain some weight I started to look like less scary and I0.96
00:24:16.400think people kind of relaxed after that like once I was kind of like out of this place where it's
00:24:21.480like okay well I'm not like fainting anymore and I'm not as underweight as I was you know I was
00:24:28.260still at that point like purging multiple times a day and restricting but like it like it passed
00:24:34.140Like I was passable in normal society, you know, it continued in this kind of like internal civil war until my third year of college, essentially like it had become so out of control again.
00:24:48.480And I was I was playing collegiate sports. I needed to go in for like a physical or something like that.
00:24:54.100And, uh, my heart rate was too unstable. And they said that I, I had lost my like clearance to play
00:25:01.720rugby. And, you know, for me, like, I was like, okay, well, I'll just, I'll keep doing what I'm
00:25:07.740doing. I kept at it. And eventually like I lost clearance to even attend school and was basically
00:25:13.860kicked out by the academic deem of affairs because of, because of that heart condition that I had,
00:25:18.600Like I had restricted myself to a place where I was like too unstable to like be on campus.
00:25:25.940And they were worried that if I had like a heart attack or some kind of heart failure
00:31:06.020You know, and at that point in time, like I had a solid head on my shoulders.
00:31:10.120I'd experienced what recovery was like in that previous time when I'd gotten better.
00:31:14.520I knew that they were telling me something wrong.
00:31:16.780and I also like didn't have the strength of myself yet and my voice to be able to kind of speak back
00:31:24.580to it right I was in my head I was hoping you like threw a drink in her face or something0.99
00:31:27.940I was imagining like a real housewives situation1.00
00:31:30.600you're just like scratching at each other for a couple minutes but that's probably not what0.98
00:31:35.080happened in real life you come back with the hat boxes from a pretty woman and go big mistake huge
00:31:41.660i did publish an article on that interaction so that was my slap back i think that's yeah
00:31:49.840that's the academic equivalent of the prank woman is the idea like that you wish you could have
00:31:56.180conveyed to those people you know if you think of the sort of three square meals a day or like
00:32:01.520the food pyramid or whatever sort of we're supposed to be eating is the idea that simply
00:32:07.540some people they're just gonna be larger than other people and that's just like the situation
00:32:12.300and we should all just accept it i just think that nourished healthy bodies come in a lot of
00:32:18.000diverse sizes like we know that human beings occur on a bell curve we know that height is a bell
00:32:23.500curve we know that weight is a bell curve there's i mean lab values are bell curves right like
00:32:28.240temperatures not everybody is a 98.6 like right i wish we focused on people being like nourished
00:32:35.140as opposed to a specific size I do think that potentially if my body story was different you
00:32:42.340know maybe if my eating disorder had lots lasted for a smaller portion of my life maybe my body
00:32:48.920would be different today I don't know that I hear that's a that's a common thing that many people
00:32:53.800think about is like if I'd never started dieting or if I never had an eating disorder how big would
00:32:58.600my body be today I don't know I think it's and it doesn't really matter because that's not a reality
00:33:03.740that I can access. But what I do know is that like, I was a thin child, I had a major eating
00:33:09.400disorder. And now when my lab values are good, and when my homeostasis is good in terms of like,
00:33:16.880oh, my blood pressure is working my, you know, I'm not dehydrated, I have good blood sugars,
00:33:23.420like when those things happen, my body is larger than when it was before. You know, that's a hard
00:33:28.760thing for someone with an eating disorder to accept because we are taught that thin is healthy
00:33:34.560and fat is unhealthy. But, you know, at least for me, like this is where my body's been happy. And
00:33:41.920this is where I've been able to, you know, have a child and, you know, sustain the kind of life
00:33:46.880that I want to live. You know, I just graduated this summer and I went through my master's in
00:33:53.840my doctoral program without any medical leaves of absences. And for me, that's a huge deal.
00:34:01.780That's like, you know, eight years of school that I did not have to leave because of an eating
00:34:07.160disorder. And by comparison, it took me eight years to get my undergrad degree because of the
00:34:12.620number of medical absences that I had to take. And so I did a master's and a doctorate at that time
00:34:18.240yeah and had a kid and this is yet another reason why it's so important for doctors
00:34:23.420and just people in general to not use weight as a marker of health because there's a lot of people
00:34:29.440who they come in and according to their bmi they should lose 20 of their body weight but if that
00:34:34.560person has had an eating disorder them being at a stable weight is a fucking huge accomplishment
00:34:40.100yes without knowing that and without asking them like let's talk through your history of weight0.99
00:34:46.000like shut the fuck up like for some people they are fine at the weight that they are and being0.93
00:34:51.980told that they need to lose weight is like a very dangerous thing to be telling people without0.99
00:34:56.700knowing what they've done to attempt to lose weight in the past yeah and a yes absolutely
00:35:03.200ask folks about particularly about their histories with disordered eating but also recognizing that
00:35:09.220based on everything we've talked about today some folks may not know because even honestly knowing
00:35:14.520that you have an eating disorder is a privilege, right? It absolutely should not be, but currently
00:35:20.780it is. So also like figuring out, you know, these are murky waters. We're all going to kind of
00:35:27.000muddle through a little bit, but the muddling through is much better than the assuming that
00:35:32.020everyone has the same sort of history or that you can tell what someone needs from you as a
00:35:37.420healthcare provider, just based on their appearance and their size, right? And also like, how do we
00:35:41.940define recovery you know right sometimes people define recovery by like maintaining a certain
00:35:46.580weight and so for me like i would have been considered recovered even in inpatient because
00:35:51.920i was still above the weight that the eating disorder center right made for me so aaron you
00:35:57.260sort of mentioned a couple of times your dissertation in here i'm super fascinated by
00:36:02.260like any and all new research what was the focus of your dissertation and what were some of the
00:36:08.280findings that you came away from it with so the focus of my dissertation was really to try and
00:36:13.620shine a light on the specific experience of atypical anorexia and to try to understand it
00:36:19.480and particularly i was interested in some of those medical experiences that i think aubrey you
00:36:25.700alluded to a little bit with like what happens when people try and get care and like does it
00:36:31.320result in people actually getting care do they get shut down like what happens and um how long
00:36:36.260does it take them and what kind of gets in the way. So I basically recruited 39 people that had
00:36:43.020atypical anorexia, a little more than a quarter of them. So a little more than 25% had never had
00:36:49.240treatment at all. And for many of them, they were kind of diagnosed through the study. We did an
00:36:54.360eating disorder assessment as part of the study. And then I followed them for a year with their
00:37:00.900disorder. They filled out kind of those quantitative scales so that we could see how people's body
00:37:06.340image and depression, anxiety, substance use, how it went over the course of a year. And then I
00:37:11.640talked with them in three in-depth interviews at the beginning of the study, six months in,
00:37:17.260and then at the very end. And those interviews addressed, like, how did their disorder develop?
00:37:23.200What was it like trying to get health care for their disorder? And how has it been trying to
00:37:28.160get better. You know, we had about 30% of the sample that was folks of color. About 20% by the
00:37:34.800end of the study had come out as genderqueer or trans. In terms of ages, people were anywhere from
00:37:41.50018, like I got one lovely volunteer who came like on her 18th birthday and was like, I want to be in
00:37:48.380this study. And then up to I think 76 was our oldest participant. Oh, wow. And some of those
00:37:55.320people had, you know, journeys of 30, 40 years of struggling with this eating disorder.
00:38:00.800I was going to say, especially considering the kinds of sort of medical impacts that we were
00:38:05.920talking about earlier, right? If you are falling down when you try to stand up, someone who normally
00:38:12.020has a period and starts missing your period and that is happening, those are significant sort of
00:38:18.180medical outcomes. When we talk about this kind of like bias and stigma stuff in treatment, it isn't
00:38:24.500just sort of like a nice bonus. It is in many cases, like very much, I would imagine a matter
00:38:30.360of life and death. Yeah. Absolutely. And like some of those long-term consequences that we
00:38:36.340mentioned earlier, like when you don't get your period for that long, that has a big impact on
00:38:40.640things like bone density, arthritis, osteoporosis. In the moment, it's like, oh, okay, like I'm not
00:38:46.480getting my period. Yay. But down the line, when these things become more chronic, it can have
00:38:51.480some really significant impacts on your quality of life later on. And also, didn't a lot of your
00:38:55.160participants try to get treatment at various points and weren't successful? Yes. The most
00:39:00.720compelling results for me weren't part of the, you know, like, yes, people waited a long time,
00:39:06.120but people were actively engaging with their medical systems, trying to get help for many of
00:39:10.980them. People presented with things that should have been caught, like those sentinel symptoms
00:39:16.660of starvation, like somebody missing their period, like somebody fainting, it should at least be
00:39:22.100occurring to us. And the fact that people were reporting these symptoms and not hiding them
00:39:25.960and presenting for care and still being told, essentially, you're too fat to have an eating
00:39:31.060disorder by many people. Right. It just completely made that, you know, what could have been
00:39:36.800a very short time without treatment, a very long time. It's also darkly funny because the whole
00:39:43.480point of like people need to be thin is for their health. So it's weird to be like, no,
00:39:49.800you'll obviously be healthier when you're thin. When most people in the population would recognize
00:39:54.660vomiting blood, passing out when you stand up out of a chair as like straightforward health risks.
00:40:01.320And it might just be better for someone to like be fat and be able to stand up regularly
00:40:06.040than the alternative. Like it seems like a pretty easy dilemma.
00:40:10.620Yeah. And I know that I'm like, I'm relying on some more extreme cases to make a point, but like this is happening. And honestly, like these types of physical consequences were not uncommon.
00:40:23.460Right. So what do we know or what do we sort of think about prevalence of eating disorders as it stands?
00:40:29.880One thing that impacts prevalence rates is how people are defining the disease of atypical anorexia and how they're either asking people or not asking people the screening questions.
00:40:42.580So, for instance, one of the studies that I found that had one of the lowest rates of prevalence for any country was a study that required people to be between a body mass index of 17.5 and 24.
00:40:55.740So if you were above a certain weight, it was impossible for you to have atypical anorexia, basically.
00:41:17.440You know, one study in 2017 used three different cutoffs, and they found that, like, with the lowest cutoff, there was, you know, somewhere between, like, 6% and 13% of people that could qualify for that diagnosis.0.98
00:41:45.240But at their highest, you know, relying on like a higher level of weight loss, they kind of estimated somewhere between 2% and 2.8%, which seems more in line with like other findings from other studies.
00:42:00.680Do you remember at our lunch at the Korean restaurant that I was trying to convince you to write a book about this that would become a massive bestseller?
00:42:21.500Yeah, I mean, it just feels like such a desperately needed conversation.
00:42:25.280And one of those places where you sort of peel back the very thin veneer of like, I'm concerned about your health.
00:42:32.060And that is used to propel so much of this stuff, right?
00:42:36.180That is like, undoubtedly, really terrible for your health, right?
00:42:40.740And it just feels like just this one entry point into a conversation both about eating disorders and about weight stigma sort of turns both of those conversations sort of on their ear a little bit.
00:42:53.060Yes. The whole idea of refusing to acknowledge the fact that somebody has an eating disorder unless they're below a certain weight, like basically unless their eating disorder is so severe that they're about to die, just feels bananas to me.
00:43:07.680It's like, we only want to treat alcoholism if you've had four drunk driving accidents.
00:43:12.840Sorry, if you've had three drunk driving accidents, I don't see the problem.