Navigating Conversations About Body Image With Your Teen

Does your teen seem overly concerned about how they look? Do they seem to overeat or restrict their food intake without worrying about the consequences? This interview with Dr. Charlotte Markey will help. Dr. Markey is a professor of psychology and chair of the Health Sciences Department at Rutgers University, and a research scientist who has published over 100 scholarly articles and chapters about mental health issues. She has been conducting research on eating behavior and body image for over 25 years. She is the author of The Body Image Book for Girls, Being You: The Body Image Book for Boys, and most recently, Adultish: The Body Image Book for Life.

In this episode, we cover:

• What do you include when you speak of body image?
• I think of it now more about weight, but wouldn’t it include having straight teeth, fewer pimples, and a cute haircut?
• Have young people always struggled with body image, or is this something new to our modern times?
• When should parents begin to worry that a teen’s concern over body image is becoming too much?
• My 17-year-old is beginning to gain quite a bit of weight, and her doctor is concerned. She doesn’t seem to be worried about it, but I am worried that she is establishing bad habits. We eat “normal,” relatively healthy food at home and have some “treats,” but not a huge amount, so she’s not gaining weight from what she is eating at home. She is driving now and stops frequently to eat fast food and then doesn’t eat much of what we serve for our meals. She also buys a lot of chips, sodas, and cookies and eats them in her room all evening. This is beginning to feel like disordered eating to me. 
• Parents worry that if they say anything, they are drawing attention and casting too much emphasis on weight.
• I have a 16-year-old girl who is very aware of her weight. I think some degree of that is normal, but I see that she is adding more exercise to her routine even though she has always been active in sports. I also see that she is eating less and less at our meals, but then she eats an entire pint of ice cream. She loves clothes and is very pleased when she drops a size. Should I be worried?
• What is intuitive eating?
• Are the body image issues for boys different than for girls?
• What teens are at the greatest risk of developing an eating disorder?
• Are youth who have experienced trauma or food insecurity at greater risk?
• Are teens with ADHD at greater risk for eating disorders, especially overeating? 
• What protective factors should we add to our kids' lives when we see them struggling?
• Where do you go first for help when your teen is in trouble?
• The impact of GLP-1 medications such as Ozempic and Wegovy on body image of teens.
• What are the impacts of social media and mainstream media on body image

Transcript

Please pardon any errors, this is an automated transcript.
Dawn Davenport  0:00  
This is Creating a Family talk about foster adoptive and kinship care. Welcome back to our regulars, we really appreciate you, and a special welcome to the new listeners. We appreciate you too. And we hope you come back. I'm Dawn Davenport. I am the host and the director of creating a family.org. Today we're going to be talking about navigating conversations about body image with your teens. We will be talking with Dr. Charlotte Markey she is a professor of psychology and Chair of the Health Sciences Department at Rutgers University, and a research scientist who has published over 100 scholarly articles and chapters about mental health issues. She has been conducting research on eating behavior and body image for over 25 years. She is the author of the body image book for girls, being you the body image book for boys, and most recently, adult ish, the body image book for life. Welcome, Dr. Markey to Creating a Family.

Unknown Speaker  0:58  
Thank you so much for having me.

Dawn Davenport  1:00  
This is such a relevant topic, I am looking forward to talking with you. What do you include when you speak about body image?

Speaker 1  1:09  
So I have a really broad definition of body image. And that I think it is not at all just feeling comfortable with your appearance, body image is are you comfortable in your own skin more generally. And there's an important difference there. Because when I say body image, I'm thinking about an important component of your identity. I'm thinking about how you interact with other people. I'm thinking about your mental health. I'm thinking about health behaviors, such as how you eat and your activity and your sleep. And a variety of things we know are associated with that sense of comfort with ourselves. You know,

Dawn Davenport  1:54  
I think that more now, and I think our society thinks that more now in reference to wait. But wouldn't it also include things like wanting to have straight white teeth or fewer pimples or a cute hair cut?

Speaker 1  2:06  
Absolutely. I mean, like I said, I think maybe because I've just done this work for so long at this point. I think it includes basically everything right? Yeah, it's not just, you know, your weight. It's not just your hair. Again, it's like, are you comfortable with yourself? And for some people having white teeth matters to that sense of comfort, but to a lot of people it probably doesn't. So I think it's somewhat individual. But haven't young

Dawn Davenport  2:32  
people, since time immemorial, struggled with feeling good in their own body? Isn't that kind of the nature of being a teen where you're questioning and you're pushing? And you're, you're looking at others and comparing? There's something different now that makes it different? Or is this the same thing that we have all struggled with?

Speaker 1  2:50  
I don't know that it's different now than it was, you know, a generation ago or two generations ago, I think you're right, that we all get a lot of messages suggesting that there are products and plans and things we should do to fix our bodies. So those larger cultural messages sort of filter down, they infiltrate our sense of who we are. And it affects then the extent to which we feel satisfied sometimes. So I do think that this isn't necessarily new. I do think the influences on body image shifts somewhat as the larger cultural shifts. Hmm,

Dawn Davenport  3:30  
yeah, that would make sense. So when should a parent begin to worry that a teens concern over their body image is becoming too much, it's becoming unhealthy? Well,

Speaker 1  3:40  
I guess, you know, we have to think about maybe what's the difference between sort of a natural concern, or spending some time getting ready in the morning, which most of us probably do, versus being really preoccupied, right. So for the most part, and psychological diagnoses, whenever something starts to detract from other areas of our life, then we start to think this is a problem, right? So if these body image concerns are manifesting by a kid doesn't want to eat dinner with their family, and that's always been an important thing that the family does, then that might be a red flag.

Dawn Davenport  4:22  
So when it's detracting from the everyday things, the wanting to play sports, they're doing well in school, they hanging out with friends, that type of thing?

Unknown Speaker  4:32  
Absolutely. Yes.

Dawn Davenport  4:36  
This is such a good interview. I hate to interrupt, but I wanted to tell you about a interactive training and support group curriculum for foster adoptive and kinship families that creating a family has. We have, I think, 25 curriculum in the library. Each curriculum is a standalone. It comes with a video, a facilitator guide handout and some additional resources. As if you also need a certificate of attendance, we have that as well. These are participatory and facilitated. It can be used as training or a support group curriculum. And we do provide training for facilitators. Check it out at parent support groups.org. That is parent support groups.org. It's all one word. All right, I want to read a question we received. My 17 year old is beginning to gain quite a bit of weight and her doctor is concerned, she doesn't seem to be worried about it. But I am worried that she is establishing bad habits. We eat normal, relatively healthy food at home and have some treats, but not a huge amount. So she is not gaining weight from what she is eating at home. She is driving now and stops frequently to eat fast food and then doesn't eat much of what we serve for our meals. She also buys a lot of chips, soda and cookies and eats them in her room all evening. This is beginning to feel like disordered eating to me. I've talked with her about what her body needs to grow and be at its best, and encouraged her to focus primarily on foods that provide this nutrition, and then have some, she puts us in quotes and junk food as the exception, but not the mainstay of her diet. She says she knows all of this but continues to do otherwise, I don't want to overly focus on her weight. But I'm not sure how to handle this since she seems to be getting out of control. But the natural consequences of this behavior, which is gaining weight doesn't seem to bother her. I've suggested and encouraged therapy, but she is adamantly opposed because she doesn't think there is a problem. So should this parent be worried? And what is a parent to do in this situation?

Speaker 1  6:40  
Yeah, I think this is a concerning scenario. But I think it's hard, you know, for me to just sort of offer a diagnosis without having more family history, greater understanding of the family dynamics. One thing I often say, though, is, if a parent is concerned, there's no harm in trying to get help. And I know that it's hard to do this if you have a young person who's not on board. But it's typically not impossible. Oftentimes, there may be a psychologist at school who may check in with the child if you make that request. Or you can suggest family therapy or you can you can try to find some way that getting some sort of professional help will be possible for the young person in your life. Maybe it's not necessary, but maybe it is. And I think it's safer to try to get that help than to just respond by doing nothing, or fighting about it. Right, because I can see this parent is probably very frustrated, I'm sure I would be in this sort of a situation as well. You're trying to calmly discuss things you're trying to offer help. The child's not being responsive, that teenager is not being responsive. So I do think that there's sort of an impasse that's been reached. And this is where it can be really valuable to pull someone else in a professional, whether it be maybe even a registered dietician, who would be willing to talk with this young person, someone who has experience dealing with eating disorders and body image, particular encase that is what's going on here.

Dawn Davenport  8:26  
You know, parents often feel between a rock and a hard place, because they worry that if they say anything, that they're drawing attention and casting too much emphasis on weight, which we also don't want to do. And yet when we see a child who feels like they're beginning to be out of control, it's that fine line between this doesn't feel normal. But are we drawing too much attention to the issue by insisting on therapy, or insisting on going to seeing a nutritionist?

Speaker 1  8:56  
When it comes to something that might be an eating disorder? My inclination is always seek out help. Because what we're dealing with is a kind of disorder that has a high fatality rate. Right? We're talking about a 10 to 20% fatality rate.

Dawn Davenport  9:14  
Well, that's Isn't that for anorexia, or bulimia, not necessarily for overeating? Not

Speaker 1  9:18  
necessarily. Oh, interesting. Not necessarily. So we want, I think, in these cases, to offer the help, because who ends up in the most trouble when it comes to eating disorder treatment is typically people who years go on before they receive any kind of help. Right? Whereas something that is addressed within a few months can be addressed relatively quickly, often, right? It's just a much easier process in terms of getting a young person sort of on track and in a healthier space. But if something is ignored, or you know, oftentimes, young people don't want to do what we think is best for them. Right. And I think that that's a tension in parenting across the board, right? Yep. Like, this is like the ongoing dilemma, right? Like, do you let the kid when they're young go to the grocery store without shoes on? Because you don't want to fight about it? Is that okay? Right?

Dawn Davenport  10:17  
I mean, and then the answer is yes to that one.

Speaker 1  10:20  
Right. But, again, maybe it depends, is it freezing out? Is it hot out? Right? I mean, there's all these sorts of little things you have to always consider. It's this never ending process of being humbled by these people that you helped to create, right? In one way or another, you are responsible. And yet, at least as far as I'm concerned, I'm never positive, I'm doing the right thing. But as a psychologist, I say, try to get the help try to even force the help, because the downside of not getting the help when it comes to these sorts of problems is so much potentially larger than getting the help.

Dawn Davenport  11:01  
Yeah. And you know, I think that the message is loud and clear with the eating disorders, such as anorexia and bulimia, which are withholding food, withholding nutrition, because the consequences are soon that you're going to face. I think it is harder for overeating disorders, because the consequences are there, but they're just so far off in the future. I don't know. Do you see that? Or is that a distinction that I'm seeing that really is a mirage out there?

Speaker 1  11:31  
I mean, I think that the general perception of what an eating disorder is has been somewhat tainted by years of media presentations of eating disorders as being like a young adolescent girl who's anorexic, right. But we actually know, the majority of patients with eating disorders experience binge eating disorder. And we know that the consequences can be really severe for binge eating disorder, as well. And it's very chronic. And it's difficult to treat. And again, early treatment is more likely to be effective. So it can be difficult because like you say, there's something very visual about someone who literally looks like they're wasting away. Right, right. So that the sort of ambiguity of like, Does this need help is not always there. Right? It seems more obvious. So I would just encourage parents and other adults who work with young people to keep in mind that any kind of eating disorder can become incredibly serious, and early treatment is better.

Dawn Davenport  12:35  
Did you know that most people find out about podcast through their friends and family. What that means is you need to be telling your friends and your family about the creating a family dot work podcast, it would really help us we want to grow this podcast because it's one of our best ways to reach the foster adoptive and kinship community and those that are supporting them. So please let anyone and everyone know about our podcasts. And we really do. Thank you. Let me read another question. I don't know that your answer will change in any way. But I want to read this one. I have a 16 year old girl who is very aware of her weight. I think some degree of that is normal. But I see that she is adding more exercise to her routine. Even though she has always been active in sports. I also see that she is eating less and less at our meals, but then eats an entire pint of ice cream. She loves clothes and is very pleased when she drops his size. Should I be worried?

Speaker 1  13:33  
Yeah, so like you said, my answer is an entirely different here. But I do think that the inroad to treatment here might be easier. So a 16 year old, hopefully is still seeing a pediatrician or an adolescent medicine doctor for a well visit regularly or that's hopefully this person has a provider they can go to. And there are some tests, not just checking weight and height, but things like blood pressure and blood work, that should probably be done for this young person to make sure that their health is stable, right, because when someone starts exercising a lot and eating less, we can start to see cardiac abnormalities. And that can be a real real sign that then treatment needs to start right away. So you want to make sure that the situation isn't that kind of serious. So you want to get to a provider, a provider will then usually make a referral right away if they can pick up on those sorts of physiological indicators of a problem. And even if we're not seeing those sorts of things, right, that blood pressure is fine blood work shows fine, you know, they're still on the height weight chart, maybe that doesn't mean treatment wouldn't be helpful. Because again at 16 Maybe this is something that, you know, recovery might be accessible within a year versus you wait five years, and then we're looking at what could become really a chronic lifelong problem. The

Dawn Davenport  14:59  
recurring theme here You're is when in doubt seek treatment and sooner treatment rather than later. Yes. And something you said I want to circle back to because I think it's something that is important, especially the first question we received where the teen was adamant about, I don't have a problem. You said something about seeking family therapy. And as I've thought about it, that seems like such a good idea. Because then it's not you have the problem. But we have a problem. I am worrying, maybe I am worrying obsessively about it, you're gaining weight? I don't know. Let's go see somebody and talk and figure out and how do we work through our relationship? How do we work through my concerns? At the same time, we could hope that the therapist also identifies that if indeed, this person's child is struggling with identify that it seems like that would be a healthy way to approach that.

Speaker 1  15:53  
Yeah, and family therapy is pretty standard treatment for adolescents with any sort of eating disorders, because young people are still typically living at home, their meals and family experiences are very much relevant to the treatment for an eating disorder. So most providers feel like you can't and not include families and treatment. But I do think like you say, it can be really valuable for the young person to hear. I'm not saying you have a problem. I'm saying we should work through this, because I'm not sure as the adult. What the best thing is, I want us to talk to someone who knows more about this than either of us.

Dawn Davenport  16:36  
You talk about intuitive eating. And that's something that's in the zeitgeist right now quite a bit. What is intuitive eating.

Speaker 1  16:46  
So at its most basic, intuitive eating, is trying to avoid a lot of the culturally sanctioned rules surrounding eating. And some of those are adaptive, but a lot of them are maladaptive. So trying to avoid those sorts of food rules, and instead, focus more on your internal signals of hunger and satiety so that you can enjoy food, and also nourish yourself appropriately.

Dawn Davenport  17:14  
Give us an example, when you say food rules, make sure everybody understands what you're saying. A lot of

Speaker 1  17:19  
the ideas in the culture about food are not particularly healthy, right? So maybe you're part of a family that tries to avoid a lot of carbohydrates, right? Or you, as an individual are trying not to eat at certain times of day. Or there's sort of a popular belief that you shouldn't eat too close to bedtime. Right? So there's all these sorts of rules, some of them are, you know, more sort of significant than others in terms of how they might impact us psychologically, a lot of young people grew up with rules, like you can't have dessert if you haven't finished your dinner, right? So Intuitive Eating kind of tries to take those things off the table, terrible pun, and instead get people more to focus on their physical needs, and also their psychological needs. So sometimes Intuitive Eating is I think, sort of misrepresented as like, eat when you're hungry, stop when you're full, and the story, but really intuitive eating does include that piece of it. But also like, what what do you feel like, right? It's okay, sometimes just to have ice cream in the afternoon, because it's a hot day. That's what you feel like, and it's summer, and you want to go out with your friends and get ice cream. Right. So you know, maybe the food rule in your home has always been like ice cream or dessert after your healthy dinner. But it doesn't have to be. Right. So it's just sort of loosening how we think about food, because a lot of those food rules do sort of lend themselves to some disordered eating and maladaptive thoughts about food and our bodies.

Dawn Davenport  18:59  
I love that you wrote a book about body image where you wrote one for girls, for boys. And for young adults, I especially was happy to see that you wrote one for boys, because we don't talk about that much at all. So are the body image issues for boys in our society different than for girls?

Speaker 1  19:17  
In some ways, they're very much the same some ways. I will say when I was interviewing boys, when I worked on the body image book for boys. I almost always start off my interviews by just saying, Tell me about your body image. How do you feel about your body right now? And you can ask a girl or a woman of essentially any age this question, and she will talk for 20 minutes. It happens to me all the time, right? Like, you can ask them 11 year old girl, and she'll have all kinds of thoughts. It turns out you can ask a boy or a man and they just look at you completely confused. More often than not, right? A few people that wasn't the case. But more often than not, they're like What do you mean? I mean, I'm fine. So then I go to the next question, right? Okay, well, tell me about your eating habits, right? And then I get all these food rules that boys and men have, I need to eat certain amount of protein or I need to not eat this or I'm not having sugar or whatever it may be, like, okay, so you have some thoughts, and it even appears maybe concerns about how you're eating. All right. Okay. Tell me about your activity habits. Do you exercise ever? Do you play on any sport teams, whatever, you know, and then more often than not, when we go to the gym, and then I do this, and I'm into this protein powder. And then, right, there's this whole routine that many boys and men have, that actually is very much about their body image. They just don't always identify it as such. And so it takes some conversation for them to go, oh, wait, why am I doing these things?

Dawn Davenport  20:52  
Because I want muscles. That's why I mean, everything you've just mentioned, is trying to present as the image of masculinity.

Speaker 1  20:58  
That's right. So the end goal may be slightly different. Well, women

Dawn Davenport  21:02  
are doing it for the societal image of beauty and a woman too, though, right.

Speaker 1  21:06  
And that does include muscles sometimes, or at least in some places. So it's not completely separate.

Dawn Davenport  21:11  
No, exactly. More. So now, I think never before Yeah, yes,

Speaker 1  21:15  
absolutely. Boys aren't necessarily trying to lose weight. Sometimes they are, they more often are trying to gain muscle. Well, I

Dawn Davenport  21:24  
think the obesity rate is pretty even, isn't it for boys and girls? I don't know if it may shift at some age, but for, let's say 18. And under isn't the obesity right about the same? Yes,

Speaker 1  21:34  
weight is pretty similar. We do see more heavier women and more consequences of that. And and that's kind of a whole nother tangent, perhaps. But in terms of boys and how they're thinking about their bodies, they often are feeling insecure. And the rates of body dissatisfaction, it turns out are very similar, maybe a little lower, but pretty close to what girls are experiencing. Now people often say, Well, isn't it healthy if a young person isn't eating sugar, and they're going to the gym? And my response? Is that in small doses? Sure, right. It's not like I think we should all try to eat more sugar, or we should never exercise. What becomes concerning is when a young person's spending a lot of time and energy and mental space on these endeavors, when it becomes more important than schoolwork, or spending time with friends, right? Again, how much does this take someone away from their normal sort of regular day to day activities. And it can and it does for a lot of boys and men.

Dawn Davenport  22:40  
Let me take a moment right now to tell you about free courses that we have on our website that are sponsored and supported by the chalky being Family Foundation. These are one hour courses that you take on your own, they're self paced, they come with a certificate of completion, if you need that, they really focus on parenting. They're terrific courses. And thank you so much doc giving family for supporting them, please check them out at Bitly slash J B F support that's bi T dot o y slash J. B F support. Now, back to this great interview. What teams are at the greatest risk of developing an eating disorder? Has there been any studies that can help us understand better who is at greatest risk?

Speaker 1  23:26  
Well, we know that young people who are dissatisfied with their bodies, and who dabble in any kind of dieting behavior, are at heightened risk. And those are two of the strongest, most reliable predictors across time. And that's also part of why, you know, my consistent message is if you're seeing these things, and you're concerned or the young person in your life is expressing concern, better to intervene, because these predictors are pretty reliable.

Dawn Davenport  23:57  
A lot of the youth that are in the families that we are supporting are raising have experienced trauma, and many of them have experienced food insecurity. Not all of course, but many and most have experienced trauma, or children who've experienced trauma, including food insecurity at greater risk.

Speaker 1  24:15  
Yeah, there's definitely some data to suggest that they may be at heightened risk of not just dissatisfaction with their bodies, but disordered eating and other mental health problems. We know that cumulative risk is important, right? So have you had trauma and food insecurity? Of course food insecurity can be operationalized as a form of trauma in itself. But we know when young people have more than one sort of heart that these things are predictive of both mental and physical health problems later.

Dawn Davenport  24:50  
Our teens with ADHD are at greater risk for eating disorders, especially overeating because of the impulsivity issues.

Speaker 1  24:57  
That's a really great question and some Other research on ADHD is relatively new. In terms of looking at body image and eating disorders, we do know that there's a link, I'm not positive that we can attribute it completely to issues of impulsivity. Okay, it does seem like there is some connection. So it's something to be aware of. But I think it may be more complex than just saying, you know, it's impulsivity, or people are apt to take risks or not to think through things. I think it's probably a little more complicated. And we just don't have that all sorted out yet.

Dawn Davenport  25:31  
Yeah. I think I have read where the incident. And again, I believe I saw that it was particularly for obesity, but that the incidence of obesity is higher with people with ADHD. Have you seen that as well?

Speaker 1  25:44  
I have I don't have those numbers at the tip of my tongue.

Dawn Davenport  25:47  
No, no, no, it's fine. I was just an I was the one who assumed it was impulsivity. But we humans are not that simple. Are we that we can just say there is one thing that is yeah, that is dealing with this. And with ADHD? It's also a little confusing, because some of the medications that are used with cause lack of appetite. So it's a little confusing in that respect, I

Unknown Speaker  26:09  
think. Absolutely. Yeah.

Dawn Davenport  26:11  
So what are some protective factors that we as parents can add to our kids lives, when we see that they are struggling, or we are concerned that they are struggling?

Speaker 1  26:24  
Well, I think it's really important to model good health and not just physical healthy, but sort of psychologically healthy behaviors, when it comes to our own relationships with our bodies and how we eat, we don't want to be disparaging towards ourselves, we don't want to talk about food is something we need to earn or it's bad if we eat it, or we're bad if we eat it, we want to really try to encourage young people to enjoy food to maybe be thoughtful eaters in terms of, you know, including fruits and vegetables and an array of a variety of foods and their diets. But we don't want food to become a bigger part of sort of their brain space than it needs to be. And we need to model that because young people learn this in their homes for the most part, right, where they often see parents who have their own concerns about their bodies, and food. And then young people learn that this is the sort of thing you just struggle with. It's just a part of life. Right? And that's not really what we want for the next generation. We don't want them to feel like their bodies are something they're at war with. We want them to feel as comfortable and secure in themselves as they possibly can.

Dawn Davenport  27:40  
So if your child, you're beginning to be concerned, like either of the two questions we received, where should you first go to find help? You've already mentioned that one step is if they're under 18, they're still seeing a pediatrician, to raise the issue with the pediatrician, I will say that things have shifted dramatically. Because what 15 years ago, the only concern was for under eating disorders. And if you raise the issue of weight gain, you are considered part of the problem. So things have shifted, though I do not see that now at all. So starting with your pediatrician. But now where else? Let's say you are concerned, how do you find the therapist? How do you find someone who will see the families and most will now how do you then go about getting help?

Speaker 1  28:28  
I would probably ask, if you have a school psychologist at your kids elementary or middle or high school, I would maybe reach out to that person because they're likely to know the resources in your community, they may be able to check in with your child and do some sort of a quick at least assessment in terms of how serious of a problem you might be dealing with. A lot of times, if you have that kind of support at the school, which is not necessarily an across the board benefit. We know, these people can't necessarily offer like weekly therapy or anything, but they can definitely check in see what's going on with your child, maybe one on one. And also they can be a really great resource. If you have questions about like, listen, I think this is what's going on. I don't know if you know anything in terms of the environment at the school right now. And do you have people in the community recommend, so I do think that can be a valuable way to start. There also are a variety of web pages you can turn to something like Psychology Today has a list of providers or I include in the books different resources at the back of every chapter, which include organizations that keep lists of providers. It's really beneficial to get someone with expertise if you can and dealing with body image and eating problems. It's a fairly unique specialty so it can be hard to find someone to be honest with But it's going to be more effective. Typically, if you have someone with that actual expertise. So I would really look around online, your healthcare provider may know someone as well. A lot of gastrointestinal specialists actually have dieticians, and psychologists as part of their teams. And so that's another avenue, especially maybe if you have a young person who's really resistant, you could try to frame it as I just want to make sure everything's okay with you physically, can we see this doctor? And that could be an avenue in if they have a whole team of providers they work with

Dawn Davenport  30:39  
have a question about that. Let me interrupt just briefly, the whole Z Olympic issue as far as any of the weight loss drugs, I think that there is a concern parents may have, if they go to a gastroenterologist, that that's going to be the first thing that is going to be suggested. And not only is there the concern about the expense, especially for a teen who is not significantly overweight, again, underweight, I think people are going to jump on much quicker, but overweight. If you're not sure, that's the yes, it's an answer. But is it a temporary answer? Is it a very expensive answer? I don't know. How do we handle that? And how do the weight loss drugs influence this whole discussion? Yeah,

Speaker 1  31:22  
the weight loss drugs definitely add complexity to some of this conversation. And I think if you are going to a gastroenterologist who deals with children and adolescents, it's very unlikely that that's going to be the recommendation, I would be very surprised if it is and I would push back against that. Because if they are used to treating young people, they should appreciate that puberty is probably not completed, brain development is not completed, weight should be gained across adolescence, eating disorders are a risk and giving someone a drug that will affect their appetite that significantly could actually cause more harm than good, I think. So I would suspect that most gi doctors who deal with young people have all of this in mind. I can't guarantee though, right? These drugs have really infiltrated our society in a way that I didn't anticipate to be honest and much more quickly than I expected. But I would not recommend if you have any concern about an eating disorder, in particular, that GLP ones are a good solution, I wouldn't recommend them for young people, period, based on the data we have, we just do not have very much long term data. So I think that's really probably not the right path to take at this point anyways,

Dawn Davenport  32:45  
no, but do you see with young people, I mean, it's everywhere. And they're very aware of it, that this is an easy way I can eat what I want and take this drug is that it becoming a concern?

Speaker 1  32:57  
I haven't really heard many young people say that yet. I wouldn't be shocked if we move in that direction. I think the reality of taking these medications and the side effects of them would disavow people of that sense pretty quickly. Because it turns out, you really usually can't eat that much when you're taking them you'll feel really nauseated, it will not necessarily go down well, there's going to be some GI symptoms if you eat too much. So there are a lot of potential complications with taking these medications, especially I think, among people who are in growing bodies. And

Dawn Davenport  33:35  
as they move into young adulthood, are you seeing things change with the use of the GLP ones?

Speaker 1  33:40  
I'm not yet because I just think they're not accessible yet as part

Dawn Davenport  33:45  
of it. They're expensive and insurance is not jumping to pay for it. Right? They're expensive

Speaker 1  33:49  
insurance isn't paying for it. Would you see more compounding pharmacies creating less expensive versions? When I say versions, we know that compounding pharmacies don't actually have the formula that Novo Nordisk has, so we don't really know what compounding pharmacies are doing. That's a good point. Yeah. So I mean, that's all the more reason, I think, for probably adults to avoid that avenue, but especially for young people, because we definitely do not have data to suggest that it's a safe medication for young people to take. We also know that from the little research we have that follows people primarily just for about two years, that when you stop taking the medication, wait is regained. So I think you really, really have to think about this. If you have a young person, let's say 18, right? Who says I'm an adult, this is what I want to do. Maybe even a health care provider is saying, Yes, I think this is a reasonable thing to try. I would have a really serious conversation with that person because at 18 Do you want to be committing to this potentially for the rest of your life, as both an X bounce something that has a lot of side effects potentially that goes with it. And we don't know what health complications could come down the road.

Dawn Davenport  35:09  
Yeah, I mean, it's still a relatively new drug. I mean, it has been around for a while, but not necessarily being used for weight loss.

Speaker 1  35:16  
No, it's only been a couple of years now that it's been approved for weight loss. When it's used for diabetes, it's used as a treatment at about half the dosage of what's used for weight loss. And so we do have, you know, 567 years of data for some people, it being used as a lower dose diabetes drug, but I have real concerns about if you double that dosage, and then put people on it for a long time, how that's going to work out, I'm just would like to see more data, especially like I said, before, a young person was to try that.

Dawn Davenport  35:51  
So any conversation about body image, it would be remiss without talking about the influence of social media, as well as mainstream media, it's not just social media. Two questions. What are your thoughts on how social media and mainstream media impact body image? I'll start with there the second question you could be thinking on, which is, What should parents do about that influence? But let's start first, what influence do you see that they have?

Speaker 1  36:16  
Well, I think we have enough data that's accumulated at this point to know that social media is a potential harm. When it comes to body image and mental health. We have to be careful how we talk about and think about this, though, because most of the research is correlational, which means we can't definitively say social media is the problem, right? We do know that some young people go looking for certain sorts of social media, because they already have a problem, right? So it's not always social media. That's the only problem anyways, so the data is, I would say incomplete. But nonetheless, we have a growing accumulation of research to suggest that can be problematic. It depends on who we're talking about, and what they're doing on social media. We know younger, tweens are more at risk than teens. This makes some sense because their cognitive abilities aren't as developed in terms of being able to sort of reason through what they're seeing and what they should make of it. We also note girls seem to be a little bit more at risk than boys. So who are we dealing with? Right? What is the young person doing on social media? This research is relatively new, we've done some of it in my lab at records even trying to understand it's not just about the amount of time people are spending, although young people in many cases are spending hours a day. Right with phones,

Dawn Davenport  37:48  
so are adults but anyway, yeah, so are adults.

Speaker 1  37:50  
And that's also probably not great, but a conversation for another day, perhaps. Yeah, so focusing on young people, you know, you know, most adults in their lives do not want them on their phone or with the media for three, four or five hours a day. Right, exactly. Still, I would say, what are they doing? Right? Are they connecting with their friends? Are they communicating? Are they sharing pictures of their pets? Some of that's relatively harmless, where we see more problematic consequences is when young people are engaged with more celebrity culture, influencers that are maybe promoting certain fashion or fitness or eating trends. And the interesting thing about social media is anyone can get on social media and call themselves an expert, essentially, Oh, yeah. That doesn't make them an expert. Right? Just because you're confident or you look a certain way, or you have strong opinions,

Dawn Davenport  38:48  
you have an opinion that makes you an expert, right? I

Speaker 1  38:51  
mean, that doesn't make you an expert. And yet young people don't always appreciate this. So it's important, I think, moving a little bit towards what parents can do, that there is some monitoring and some media literacy that is developed in the home in terms of helping kids to appreciate that just because this person is making a recommendation doesn't mean that that's a good recommendation. And

Dawn Davenport  39:14  
just because they look this way, we don't know. They're showing you one aspect of their life. They're not showing you the full thing. They are showing you a very curated version of their life. And that's why I think younger, especially our younger teens are more susceptible. I hope that our older teens are wise enough to read through that. Yeah,

Speaker 1  39:35  
I think it's difficult, right? A lot of the information on social media is just, it's really compelling to all of us. I mean, it's fast. It's catchy, right? I mean, these platforms are making it easier if you're posting to integrate music to make it more exciting, right? I mean, so it's no wonder that young people are fascinated and captivated for hours a day. One thing that I often suggest parents try to do is if you are giving your child permission to be on social media that you try to set some boundaries in terms of when they can and can't use it, or install some software that can help to monitor that. So you can provide some limits. But I think perhaps even more important is, you know, you can get on whatever platform it is Snapchat or whatever, tick tock. But you know, in the beginning, once a week, I want us to sit down, and I want to see what you're doing. Right? Sit down and engage with your child and look at what they're doing, and try not to be judgmental, but try to ask questions, you know, why are you following that person? Do you think that seems like good advice? You know, I feel more comfortable, maybe if you were looking for people who actually have expertise about this, if you're interested in it. Right? So So sort of being as gentle as you can be? It's hard, right? When you know more? Yeah. And you're worried about it, right.

Dawn Davenport  41:00  
But here's the problem with that, from a parent's standpoint, is that it's fine. You can say to your kids, okay, I want to know your social media accounts, and we want to sit down and talk about it. But then they just create a fake account created account with a different name. They can, they can, yeah, so as parents, we think we have control over it. But the truth is, you can say you're not allowed to do that. But yeah, yeah. Keeping our tweens off, I think is just why anybody under the age of 13 is on social medias is beyond me. I don't understand that. But anyway, well,

Speaker 1  41:36  
I mean, technically, you're supposed to be at least 13. But we haven't, as a society really embraced this, I think, as a rule, and we haven't found a way to implement some sort of age licensing, which I wish we would do. I think you're right, I think before 13, it just doesn't seem like the best idea.

Dawn Davenport  41:55  
You can go put parental that will prohibit phones, or tablets from accessing social media, you can do that. But that gets harder as your kids gets into their high school age. It's easier for a 13 year old than it is for a 16 year old.

Speaker 1  42:09  
It is and as you pointed out, kids can be very sneaky when they're motivated. Right? They can create a fake account. One of my own kids at one point was installing an app and then uninstalling it when we would check her phone. And then reinstalling it right. So I mean, at some point, we figured this out. We are just trying to set what we thought was a very reasonable not even that strict boundary. Right.

Dawn Davenport  42:34  
But she was smarter too. Yeah. But she asked. Right, you

Speaker 1  42:37  
know, as I said, parenting is humbling. Yeah. Amen. On that one. Right. You won't be outsmarted? Well, you are dealing with young people who are often more tech savvy than we are. They're

Dawn Davenport  42:48  
digital natives and social media natives. Right.

Speaker 1  42:52  
But I don't think that means we give up I think still, we try to use it as a way to connect, right? So we used to, in sort of the parenting and developmental psychology sphere, talk about, you know, watch television with your kids. Even if it's something where kids are doing things that are very risky, that's okay, you just use as an as an opportunity then to have a conversation about drugs, or sex or whatever it may be right. And I think that there's sort of an analogous way to proceed when it comes to social media, you can sit down and try to see what they're doing. Maybe it's not they're really doing. That's true, where we may never know everything. But I don't think that means we shouldn't try to engage them to use this as a way to kind of maybe get to know what they're thinking. If nothing else, it teaches us something about popular culture, typically, which I think is sort of interesting sometimes. Right? I learned about, you know, musicians that I never knew anything about when I've done this. Yeah. And it's an excuse to have a conversation, right? I mean, adolescence, as they go from tweens to teens in particular. Often, it's still surprising to me how little they want

Dawn Davenport  44:00  
to talk to us. And we're so cool and fun. Why don't they watch your toy?

Speaker 1  44:04  
I don't. I don't understand either. I don't I keep telling my kids how.

Dawn Davenport  44:10  
Me too.

Speaker 1  44:10  
But here's the thing, right? If you say I want to talk about social media, that's something they care about. That's something they're interested in,

Dawn Davenport  44:18  
and they know more about it that many times and know more about it, so we could actually learn something. Yeah, so why

Speaker 1  44:23  
not try? I think eventually. I don't know how far out it may be. But I do think eventually we'll probably have some real age licensing 13 or 14 or who knows what it is. But right now we have a lot of kids who are growing up with almost free access. And so we have to have some conversations. We have to talk about having some boundaries, you know, the no phones in your bedroom or in bed or at night or during meals or whatever it may be. I used to tell my kids when I was driving them someplace, they could not look at their phone when they had to talk to me.

Dawn Davenport  44:59  
Right If that's what you owe me for drives right here, yes, right?

Speaker 1  45:02  
If I'm driving you to the mall or to your friend's house, this is 10 minutes, just keep your phone away. Suck it up. You can you give me 10 minutes? Yeah, right. But I think that these are impulse control lessons, essentially to learn something like car time or dinner time or before bedtime can be really good time to engage with young people.

Dawn Davenport  45:22  
And let's be honest, there are so many parents, and I'm not really casting stones, because I've been known to do this as well. But it's tempting to pull out your phone as well. And to force kill time rather than, particularly with little kids. You can only watch Paw Patrol so many times, and then you just have to whip out your phone while they're watching Paw Patrol if you have to be stuck in the same room. So yes, there is some modeling Yes. from social media that can go on. And I don't say that again, with judgment. I say that with compassion.

Speaker 1  45:53  
Of course, of course. I mean, it's all tricky. There's no real absolutes here, I think because maybe you want your kid to avoid all kinds of media, but you're in a doctor's waiting room and they're sick. And that's gonna keep them entertained. Oh, amen. Oh, for it a right. Absolutely. Do it. You're on a long car ride. Yeah, right. You know, at some point, whatever keeps them happy. And

Dawn Davenport  46:17  
whatever keeps everybody in the family saying exactly. It's not black and white, just like eating and food is not good food and bad food, per se now quantities. And then there are exceptions, even that, where you just you want a pint of ice cream and what the heck, right? Yeah. Well, thank you so much, Dr. Charlotte Marquis for being with us today to talk about body image and our teens. And I want to encourage everybody you have three books to choose from. You have the body image book for girls, body image book for boys, and then adult ish, which is the body image book for life. So you've got your choices out there. And, and I will say that if you've got teens, I would also encourage you to pick up adult ish because your teens will be moving into that area. And I thought it was a good intro into things that we need to be focusing on with our teens as they're moving into young adulthood. So thank you so much for being with us today.

Unknown Speaker  47:16  
was absolutely my pleasure. Thank you for having me.

Transcribed by https://otter.ai