Episode Transcript
[00:00:00] Speaker A: This show is not a substitute for professional counseling and no relationship is created between the show host or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling center at 348-3863. If you are not a UA student, please contact your respective counties crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emerg.
[00:00:40] Speaker B: It's six o' clock in time again for Brain Matters, the official radio show of the UA Counseling Center. We are broadcasting from the campus of the University of Alabama. Good evening. My name is Dr. B.J. guenther. I'm the host of the show along with my colleague and producer Kathryn Howell, who's usually here but she couldn't join us today. She'll be back next week. And in case you don't know, this show is about mental and physical health issues that affect college students, in particular UA students. So you can listen to us each Tuesday night at 6pm on 90.7 FM or you can listen online at WBUAFM UA edu. You can also download some apps and get us that way. I like the MyTuner radio app and just type in WVUAFM 90.7 and you'll find our past shows there. Also, if you have We've almost got I think we've got all of our topics for this semester scheduled out because our last show is going to be on I think It's December. The 10th will be our last aired show and then we'll start with the spring semester because we don't record shows in the summer. So we'll start with spring semester in January when we all get back.
So I need some ideas for show topics. So if you're listening and you have an idea that pertains to college mental health or physical health, even email those to me@brain mattersradiovuafm ua edu and I'll consider using your show topic and I'll try to remember to give out this address after each break. I always forget and that's why I miss Katherine so much.
Tonight. I was just talking with our guests because it's been a while since I've had anyone on the show talking about eating disorders and I feel like that is a topic that we need to address, especially on a college campus, probably every year at least. So I'm glad we're going to be talking about eating disorder tonight because it's an Issue that affects far more college students than I think many people realize. And eating disorders, how treatment is evolving to meet students where they are. That's very important. So I'm tickled that we're really talking about this tonight because I think, I hope a lot of people will be hearing this and maybe take it to heart. Joining us is Katherine Jordan. Katherine is the director of nutrition services at Alsana, one of the nation's leading eating disorder treatment centers. And she oversees Alsana's innovative. Or she did, and we'll explain that in just a minute. Oversee. She used to oversee Alsana's innovative virtual care programs, which provides comprehensive evidence based nutritional support to clients across the country, including college students who often struggle in silence. So her work has focused on compassionate, accessible care that blends clinical excellence with real world flexibility and something especially important for students trying to balance classes, stress and recovery. We're so grateful to have her on with us tonight and to talk about the unique challenges facing young adults, the role of virtual care and how it can play in early intervention and also recovery. That's absolutely possible with the right support. Katherine, thank you for being on the show.
[00:03:47] Speaker C: I'm so glad.
[00:03:48] Speaker B: Long introduction, I know.
So explain a little bit. Like you've just been placed in the position of director of nutrition services. When I invited her to be on the show, her role was vice president of virtual Nutrition services. Is that right?
[00:04:02] Speaker C: Yes. You got it. Yeah. I've, I've actually been with Alsana for, it'll be 10 years this summer.
Started at Alsana right after I actually graduated from grad school at the University of Alabama. So roll tide. I was a dietitian there. I was a lead dietitian there at our location here in Birmingham. And I'll talk more about some specifics there. And then was the clinical director of our Birmingham location. In July, I moved into director of virtual nutrition services. So I was just overseeing our virtual program.
And then actually about two weeks ago, I moved into the director of nutrition services for Asana as a whole. So overseeing dietitians across the company across the US So it's very new. I'm still getting used to the title as well. But it's very exciting to just be able to have like a greater footprint for the, in the company as a whole.
[00:04:52] Speaker B: So, okay, for people listening and may not, who may not be familiar, what is Alsana?
What makes your model of care different from traditional eating disorder programs, treatment programs? Is it only in Alabama or is it nationwide? Great question.
[00:05:07] Speaker C: Yeah. So Alsana is an eating recovery Community and treatment provider that treats adults and adolescents, all genders, and really the goal is to support them in having a long lasting recovery from their eating disorder. So we offer in person treatment in Birmingham, Alabama and then in a handful of cities in California.
But what I think is pretty unique is we offer virtual treatment like over 30 states. I won't list them all out. You can buy them on our website.
So that is, I think newer. Our virtual program actually started pre Covid, but it has expanded and the desire for virtual care has greatly increased over the past few years, which has kind of led us to expanding and hopefully will be in 50 states in the next year or two, but in 30 plus right now. So that's kind of where, where our, our footprint is in the US What.
[00:05:59] Speaker B: I guess I don't know how to ask this. What constitutes virtual treatment? Like how do you know whether virtual treatment is the appropriate avenue to take?
[00:06:11] Speaker C: No, that's a great question. Because it's, I mean most of the time virtual would be preferred, right? You get to stay home, you don't have to travel, you don't have to live somewhere else.
We have like a pre intense like admissions process where we do an assessment and we really are looking at medical stability. So if someone is not medically stable, then virtual is probably not the best option for them.
If they have a doctor and a dietitian and a therapist in their community who's following them very closely, we may be able to partner with them.
But I feel like the medical piece is probably one of the, the most like determining factors of whether someone's appropriate to do virtual or they need to come in person. Some people actually really love the in person aspect because there is a little bit more connection when you're in person. Of course we've grown in how we connect virtually as a society as a whole. But there is something about being in person with people. And then some people also need to leave their environment in order to heal. And so some find that virtual is not the best option for them because they actually need to like leave their state or leave their home or leave kind of the environment environment their eating disorder thrives in for a time period to heal and to be able to return back home. So it's not, you know, different people benefit from different types of treatment.
[00:07:29] Speaker B: You mentioned y' all treat adolescents. What's the youngest age you've seen or the youngest age that you will treat?
[00:07:37] Speaker C: I think depending on the state, like 12 to 13, which is about the youngest that I've seen.
[00:07:42] Speaker B: Okay.
[00:07:43] Speaker C: But I do know. I mean, colleagues have treated clients as young as 6 years old.
Yeah, it's getting younger. When I started, 8, 9, 10, was probably typically the youngest. And now I do hear, like 5, 6, 7 year olds that are struggling with eating disorders.
[00:07:58] Speaker B: You know, when you mentioned just now, you mentioned needing to get out of the environment sometimes. Is that because.
I don't know how to say this. Is that because it runs in families or it's perpetuated by the family? Because I have had the experience of that with a few of my clients where they're parent. One of their parents makes it worse. I don't know any other way to say it.
[00:08:22] Speaker C: Yeah, so I believe pretty firmly that, like, families don't cause eating disorders. We do know there's a genetic aspect. So from that regard, yes, there can be genetics involved.
But I have, you know, told a lot of mothers, like, you did not cause this.
But there are different maintaining factors. And so I do think families, like relationship with food or the diets they're engaging in or the way they're talking about food or communication styles, those are. Those can be some maintaining or perpetuating factors that could. Without being processed or navigated, like in family therapy, those could be barriers to recovery or kind of like triggers that could lead to more eating disorder behaviors. So I think in those cases, and sometimes, like, the environment itself just represents, like, maybe a client has had an eating disorder their whole childhood and just represents that. And so I think sometimes the physical kind of manifestation can also just be shaken up by traveling to treatment.
[00:09:24] Speaker B: Well, I think the family sometimes don't know they're doing it, you know, because they haven't had that education.
[00:09:29] Speaker C: Of course, yes, typically it's not malicious. Typically. It's just that it's what the family knows and they don't. Yeah, they don't realize that it's just a habit.
[00:09:37] Speaker B: It's like a habit, you know, the. The role of virtual treatment or virtual nutrition.
How. And I think we've answered this a little bit, but I want you to expand on a little bit more. How is that advantageous for college students?
[00:09:53] Speaker C: Yeah, I mean, virtual treatment, like, really changes the game. And I be the first to admit. So I said, I've been in the field for about 10, 11 years now. And when I first heard, like, virtual treatment, I was very skeptical. I was like, how could this be done? And then I actually got to see some of the data, and I was like, whoa. According to, like, the assessments that our clients are completing, like, they're getting better. In virtual treatment. So I was. It took me some time, but I think where.
I mean, majority of time, college students concern in seeking treatment is having to withdraw from school.
[00:10:29] Speaker B: It's. It's missing out. Yes.
[00:10:31] Speaker C: It's social, it's grades, it's sports. Like, fill in the blank. I totally get that. Like, colleges is a great time. And so I think that probably one of the biggest advantages to college students is just the opportunity. Like, hey, you can be in your dorm room and attend treatment for three hours in the evening after you complete all your classes. Or you can be in a private space in the library.
[00:10:53] Speaker B: Library.
[00:10:54] Speaker C: And attend treatment for three hours in the morning before your classes even start.
So I think being able to simultaneously attend treatment and go to school can be like. I mean, that's pretty incredible.
[00:11:05] Speaker B: That's pretty incredible. And I can remember the options were limited. Yes. When I first started working here and having to, I don't know, encourage someone, I'll say, to go into treatment, it was very difficult. They were very resistant. When we didn't have the services enough, like, you know, like what you're talking about, even the medical or the nutritional, because it takes a team approach. And, you know, we didn't have that necessarily back then. And it was just very difficult to get somebody to go because the only option sometimes was going into treatment or going something, you know, driving somewhere.
And that would deter people from getting treatment.
[00:11:48] Speaker C: Yeah, it deters a lot of people. But I think that even more so in the college community because, like you said, missing out, it's really.
[00:11:56] Speaker B: Oh, it's difficult. Okay, let's take our first break. When we come back, will you take an email question?
I'm looking at it right now. So we've got four or five email questions to get through. So we'll be right back. You're listening to brain matters on 90.7 the capstone.
[00:12:22] Speaker C: Wvuafm Tuscaloosa.
[00:12:25] Speaker A: This show is not a substitute for professional counseling and no relationship is created between the show host or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling center at 348-3863. If you are not a UA student, please contact your respective counties crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 900 or go to your nearest emergency room.
[00:13:03] Speaker B: Hey, you're back listening to brain matters on 90.7 the Capstone. I'm BJ Guenther. We're talking tonight about how Alsana helps rebuild mind, body, and spirit. That's what I've titled the show today, because we're talking with Katherine Jordan, who is the director of nutrition services for Alsana, which is a incredible treatment program. She's just given us basically, the details at the beginning of the show. So go back and rewind that if you didn't hear that part. How. I mean, how important are the different aspects? I mentioned teamwork. It takes a team talk about the different spokes of the wheel for the team. Nutrition is one already. That. That's. I don't know if that's the most important one. What, you know, maybe they're all equal. What are the different aspects of the team that's going to somebody who has an eating disorder?
[00:13:55] Speaker C: Yeah, that's a great question. And it's so important.
We kind of coined it as our adaptive care model at Alsana. So you've got the nutrition, the therapy, and the medical. Obviously, nutrition is. We're talking about the relationship with food. We are looking at the meal plan, and we're looking at protein and fat and carbs and some of the nitty gritty of it. But we're really looking at what's underlying the beliefs about food and the body.
I think nutrition and therapy pair very, very closely together when it comes to eating disorders, because I often say it is about the food, but it's not about the food. Food is kind of almost like the symptom of what's going on underneath. And so we're using restriction or purging or binging or exercise as a way to navigate and cope with the distress that we feel underneath. So the therapy obviously really parallels the nutrition.
Medical is huge because eating disorders affect every system of the body. So regardless of what behaviors are happening, every system of the body is impacted by lack of nutrition or whatnot. And then the other two aspects, which are a little unique to Alsana, are relational and movement. And so relational is this idea that our eating disorders impact the way we connect with one another.
So it impacts the way we connect with ourselves, the way we may connect to a higher power or spirituality. It impacts how we connect to one another. And so we really want to take that into account when we're looking at, like, treating the whole person. And the last one I mentioned was movement.
So we at all sauna kind of feel that we were, like, created to move our bodies. And so with the treatment of eating disorders, we want to look at that. So is any exercise happening? Is it happening too much? Is it not happening at all. Are we avoiding it? So we really bring that into the process and that's probably under kind of the dietitian umbrella. But obviously the therapist is also discussing that because there can sometimes be potential trauma related to movement or potential messages that this person heard as a child. And so those are kind of our five kind of spokes. But I do feel like from a treatment team standpoint, dietitian therapists, psychiatrists, obviously there's a lot of secondary typical diagnoses, anxiety, depression, ocd, that kind of often coincide with eating disorders. So we want a psychiatrist on board if possible. And that's typically who I kind of see as the main treatment team members.
[00:16:20] Speaker B: Do you with, with regards to medical.
Have you found that when clients are faced with their medical results, is that, does that help them accept treatment more or better?
Do you know what I mean?
[00:16:36] Speaker C: It depends on the client. Sometimes, yes.
I see kind of the opposite happening a lot where if they have normal labs, really, I'm good. I don't need treatment. You see what I mean?
[00:16:47] Speaker B: Yes, I sure do. Because I've had them come back in here and say the same thing. You're right.
[00:16:52] Speaker C: It's like, no, I'm good. Like the idea like I'm not sick enough for treatment, that comes right. A lot.
I think for some clients who are maybe more in that denial stage, giving them some concrete details of like this is how impacting your body can be helpful. But eating disorders are dark. They're dark disorders. And so there is sometimes the refusal to believe it to be true or like this belief that I'm invincible and like, oh, my labs are bad, like I feel fine. And so sometimes they're wrong.
[00:17:23] Speaker B: Yeah, yeah.
[00:17:23] Speaker C: Sometimes they can dismiss some of the medical stuff. But there is a, there is a population in which it can be a little bit of a wake up call at times.
[00:17:30] Speaker B: Wow. You know, you talked a little bit about the different, different behaviors. Tell us the different types of eating disorders. Though for people who are listening, who just think it's bulimia and anorexia, that's not the case.
[00:17:46] Speaker C: Yep. So probably the three most common. You mentioned bulimia and often bulimia is, is going to be described as like some sort of compensatory behavior. So I'm going to eat, but I'm going to throw up or I'm going to eat and use laxatives for eat and exercise. So that's typically kind of of this is giving a very brief overview.
Anorexia is gonna more often be like just restricting intake so not eating enough calories. There is a subtype of anorexia. I'm getting into the weeds here.
[00:18:14] Speaker B: I need to hear this. I need to update it myself.
[00:18:16] Speaker C: It's anorexia, binge purge type. So it's gonna have the similar behaviors as bulimia. Right now, the difference in criteria has to do with weight, which I don't love because we are trying to get away from weight as like a primary indicator of health. But that's still what the DSM is saying right now.
[00:18:32] Speaker B: DSM is what we use to diagnose in case you don't know and you're listening.
[00:18:37] Speaker C: Yes. Thank you.
The third, which is actually the most common is binge eating disorder. It is the most common eating disorder, but is the least likely diagnosis for someone to seek treatment. There's a lot of stigma out there about clients living in larger bodies. There's stigma in the medical field, you know, and so even though it's the most common, it's the least that we typically see seeking treatment.
And binge eating disorder is, is just, just is binging, which is kind of defined as eating quickly, eating mindlessly, maybe large quantities of food, but there's no compensatory behavior. So there's not any like exercise purging that occurs after that. And then there are some less common and probably less known eating disorders. ARFID is avoidant restrictive food intake disorder. And that's going to be restriction or not eating enough, but it's not perpetuated by body image. So the goal is not to lose weight. It's. It has a variety of subtypes. So it could be I had an allergic reaction to food and now I'm terrified to eat again, or I choked one time and now I'm terrified to eat.
[00:19:45] Speaker B: Or they just don't. Like we did a whole show on arfid, or they just don't like the texture. Yep. I've had a couple of students who just didn't like the texture and they only ate three things. I could not believe it.
[00:19:55] Speaker C: And we often see ARFID intersecting with neurodivergent clients. And so that is a pretty common. Again, that's texture related.
So there's a lot of different subtypes of arfid, but it's going to be. It typically can lead to like weight loss or not being an appropriate weight due that lack of interest to food. And then the last category, it's a little bit of the catch all. It's other specified feeding and eating disorders. So I feel like typically when you're diagnosing if you can't quite figure out where a client fits other diagnoses. There's some like different subtypes in that last category. So those are all that's in the.
[00:20:33] Speaker B: DSM 5 right now is, is orthorexia in there?
[00:20:36] Speaker C: So it's not, it's not currently orthorexia technically often will fall under that other feeding and eating.
[00:20:43] Speaker B: Okay. Because we did a show on that too when it was first introduced. Nobody really had heard of it, you know.
[00:20:48] Speaker C: Yes, I, I most often find that clients with a diagnosis of anorexia typically have what I call like orthorexia tendencies, typically not eating enough. They maybe had a low body weight. So that's typically where I see that subtype fit. But I think it can also go under the other specified feeding.
[00:21:09] Speaker B: Okay, I promise I'm going to get to the email questions in a minute for those that are listening and anticipating.
But I've got to ask this. What are the red flags people should be looking for?
[00:21:21] Speaker C: Yeah, I could go on about this for a while, but I feel like, I mean any sort like skipping meals, avoiding like social situations where food is present, like avoiding going out for dinner or avoiding going to the dining hall with friends.
I think what's tricky is there can be a lot of just like hyper fixation on like the menu, the calories, the food, not eating this, eating that, the next, diet, that sort of thing.
Excessive exercise could also be. It's like missing class to go to the gym or missing a social engagement to go run or going to a day.
[00:21:56] Speaker B: I have go in the morning, in the afternoon. And in my mind I'm like, I don't know about that.
[00:22:01] Speaker C: Yeah, yeah.
Hiding food. Hiding food wrappers.
Sometimes our clients will wear like looser clothes, which could be twofold. It could be to hide like weight gain or loss, or it could also be to avoid body image.
I also typically see like an increase in irritability or like just low mood. I mean, when we're hungry and when our blood sugar is all off, it's pretty that we are irritable and we have poor moods.
Those are probably some of like the most, maybe more obvious or like kind of in your face.
It's hard because we do live in a society where it's so normal to talk about your diet and your calories and what you ate. And so even though that is a pretty common sign, you also could have people that talk about that and actually don't have a clinical or subclinical eating disorder.
[00:22:48] Speaker B: I guess so.
[00:22:49] Speaker C: Yeah.
[00:22:49] Speaker B: Yeah.
[00:22:50] Speaker C: But that's kind of my. Those are just some of my go tos that I.
[00:22:54] Speaker B: Well, the first question I have doesn't really have to do with that, but a little bit, I guess it could.
For people who are living with somebody that they may suspect. This question says, is the approach different for students who live in dorms regarding dining hall, foods and access to personal space and privacy, like in traditional dorms?
[00:23:19] Speaker C: Can you ask it one more time?
[00:23:21] Speaker B: Is the approach different for students who live in dorms and then in parentheses regarding dining hall, foods and access to personal space and privacy, like in traditional dorms?
So I guess they're asking is, you know, because you're closer, you know, you're in closer vicinity kind of, you know, like if you have a roommate or. The thing about our dorms here that we, I remember when they built our dorms, we kind of were concerned because everybody has their own, the newer dorms, everybody has their own private rooms and they can lock and you know, stay in there and hide basically.
[00:23:58] Speaker C: Sure.
[00:23:59] Speaker B: So roommates may not know what's going on. Nobody.
[00:24:02] Speaker C: Yeah.
[00:24:03] Speaker B: May know.
[00:24:03] Speaker C: And I think one of the things about eating disorders is they are very secretive and very like base in shame.
[00:24:12] Speaker B: Oh yeah.
[00:24:13] Speaker C: And so I feel like, like when it comes to supporting a roommate or a friend who you might think is struggling, what I typically find is that on first like approach I, that person is typically really defensive and maybe angry and maybe lashing out. You don't know what you're talking about because they're starting to be kind of like found out. The disorder is starting to be revealed.
[00:24:35] Speaker B: Yeah, exactly.
[00:24:36] Speaker C: In actuality, I think it's really freeing that like finally someone is noticing what I'm going through.
So I do think like some gentleness and some patience to allow that person to like come around.
I definitely, I mean I, I think it in gentleness you can like reflect some of the things you're seeing. So again, if you're in those really close quarters and you're like, you're very much seeing that your roommate is not eating until 9pm or you very much hear your roommate purging in the bathroom, like I definitely think that is appropriate to have a conversation. I always say like using I statements. So like sharing how I feel and not accusing your roommate of something.
But I do, I always like to tell people, like expect for them to be angry at first, but don't, don't like give up on supporting them. I also think about, and this is maybe more so for like loved Ones or parents, but it's pretty normal, like, checking in with your friend, like, hey, how are you sleeping? How's your stress? Like, college is a.
[00:25:39] Speaker B: And it depends on how close you are.
[00:25:41] Speaker C: That's very true. That's very true. And what's your. What's your. What's your motive? Because that usually comes through like, are you trying to be nosy? Or do you care about this person and you want to support them in getting help?
But, like, checking in as a human of, like, hey, how's your eating habit? Like, I just feel like we. We talk about sleep, we talk about stress, we talk about health and different aspects, but we often don't really ask about, like, are you eating regularly? Like, that sort of thing. And so that's another kind of gentle way to potentially go about it.
[00:26:10] Speaker B: Yeah. I remember the first student I had who had an eating disorder, and it was severe. It was severe. The way that person was referred to us here at the counseling center years ago was.
They were purging in public spaces, and it was causing a public health crisis. That's the truth. And so there were. There was some leverage with some organizations she was in. I'll just say that. And so when she came to me, it was kind of the opposite for me, and maybe it was because I'm a therapist, but she was very accepting at first, until I had to make the referral to a higher form of treatment. I'll say it like that. And she went ballistic on me, and I went ballistic back on her, because that's me. I'm blunt. Yeah, I did. Unbeknownst to me, my colleagues were standing outside the door because we were going at it. But do you know, she did follow through with treatment, and I saw her years later, and she thanked me. She remembered me. So, you know, it's hard.
Yeah, it's just hard. Whether you have professional training or whether you're a roommate.
[00:27:19] Speaker C: Yep, it's hard. And you typically won't regret it. You know, you may regret. You may regret not saying something years down the road. And it's a great example, bj, of like, hey, in the moment. But, like, for her to come back years later and say, you know, you.
[00:27:34] Speaker B: Eventually, almost, it meant something. Like, yeah, it didn't matter. It did matter. Okay, we're gonna take another break. It's going by when we come back. I've got several more questions. I don't even know if I'll get to the questions I've actually prepared for the show, so we'll just see. We'll Just go with it. You're listening to brain matters on 90.7, the capstone. We'll be right back.
[00:28:02] Speaker C: Wvuafm Tuscaloosa.
[00:28:05] Speaker A: This show is not a substitute for professional counseling and no relationship is created between the show and hosts or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling center at 348-3863. If you are not a UA student, please contact your respective counties crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
[00:28:43] Speaker B: Hey, you're back listening to brain matters on 90.7, the capstone. I'm BJ Gunther. We're talking tonight with the director of nutrition services at Alsana. Her name is Katherine Jordan. And we're talking obviously about eating disorders and basically true treating the person as a whole. And you've already mentioned that, Kathryn. And we just talked a little bit about, you know, when to confront somebody, when to talk to someone that you suspect might have an eating disorder. It's, it's tough and it's hard to know when and it might not go well. Yeah. As I gave in my example before the break, another email question. What do clients say is the most helpful in their recovery?
Oh, that's a really, that's a good question.
[00:29:30] Speaker C: The fur I would want to like, think more deeply about it, but I'm going to go with my first gut and it's support, I think finding people around you that you can trust that know what you're going through, that maybe know what your triggers are.
Finding people like a community that's not, that has more important things to talk about than somebody gaining or losing weight and their diet. That's really important so that you can go out to dinner and like enjoy conversation and not be worried that someone's going to say something, triggering people that you can confide in, whether it's friends or providers, when you do start to struggle. Because I think when it comes to recovery, one thing that I think about often is there's going to be slips, right. Like we're human, there's going to be missteps. But I think about how important it is to confide in someone if you do start to slip versus staying in the secrecy and the shame and then it goes to a full blown relapse and then you're kind of back in treatment. And so I think finding good support is probably one of the most, the.
[00:30:27] Speaker B: Best thing, you know, you mentioned support and, and being in secret or either people knowing the thing that I have heard too. And with the holidays coming up, we always have an influx of people worried and coming in and not wanting to go home or worried about the food, basically it's going to be served, et cetera, et cetera, but also worried about, like, whoever knows at home, like, let's say they've told their mom. Mom and being watched.
Do you ever have people talk about that? Like, knowing that your mom knows, maybe nobody else knows, and you're moving your food around on your plate and she's watching you, not. Not being bad, not being mean about it, but just watch.
[00:31:12] Speaker C: Yeah. Yeah, I definitely think that happens frequently. And in some ways I'm like, I don't blame Mom. Like, mom is just scared. And I have to remind clients that a lot. Like, like, it may seem like mom is overbearing. It may seem like mom is watching you, but mom is scared.
She loves you and she's worried about you. And so I think her potentially, quote, unquote, watching is a way that she's trying to support.
So then I just go also to, like, communication. Like, are you communicating to mom how it feels? What's mom doing? Again, trying to use those I statements. I feel this, you know, when I'm being watched or whatever. So I do think reminding clients that, like, often loved ones are acting from a place of fear. And then the part two would be like, how do we clearly communicate with loved ones? Like, what is helpful and not helpful?
[00:32:00] Speaker B: Yes, that's the big one.
And I think sometimes once you're outed, it is a relief.
[00:32:06] Speaker C: Yeah, it is. I've heard that before.
[00:32:08] Speaker B: Here's the same person's asking three questions, and this is the third question. What are the challenges that are unique to college students?
[00:32:17] Speaker C: Yeah, I mean, I could probably spend the rest of the radio show talking about this.
I mean, the fur. Well, okay, here's what I often find. So what we know from research is that the onset of eating disorders is often in adolescence. However, I feel like college is where things go one way or the other. I feel like college is usually where clients go full blown to their eating disorder or they kind of grow in autonomy in themselves and they get out of their environment and they're able to, like, shift away from it. So I think autonomy can be a great thing. But it's also like, you no longer have supervision around grocery shopping and what you're eating. And when you're eating a lot of People pre college, they have people buying groceries for them, and they have maybe dinner made for them or lunch packed for them or question. And so, I mean, that's huge. I also just think, like, the social pressures of entering into a new environment, trying to make new friends, figure out where your place is. I think a lot of our society really idealizes thinness. And so. So if being thin is how I fit in, then sometimes there can be an increased pressure to, like, lose weight at college.
There could be. I mean, social media, obviously that's not just a college thing, but I do feel like that age group, it's probably most prevalent uses from, like, high school to college. And just the way that, I mean, social media, like, it's comparison not only to peers, but also to, you know, influencers and celebrities.
There's a lot out there of like. Like before and after pictures and what I ate in a day and all these workout regimens and inspiration. And I think that can be pretty pivotal trying to think of what else is. I mean, it's also just stressful. Like, the transition is just. It was at least personally, like, the transition from high school to college was way different than people painted the picture to be. It was lonely. I was trying to figure out school. And so again, it's about the food, but it's not about the food. So I also think, think we may use different coping skills that are not adaptive. They're actually maladaptive, like restriction or exercise or binging to try to manage the stress. That's just natural from the transition to college.
So those are probably the top things that come. That come to mind.
[00:34:36] Speaker B: What do you think are the trends now with this population, with college students?
[00:34:41] Speaker C: Oh, gosh. Well, I think what's very tricky, and I don't. I don't fully know because I've been out of it for a little while. But I think what's very tricky is that, you know, years and years ago, it was all like. It was diets. It was the Atkins diet and weight loss, you know, And I think we in the past, probably eight years have have drawn more to this idea of, like, wellness, which is not a bad thing, right? Wellness is not a bad thing.
[00:35:09] Speaker B: I know where you're going. Yeah.
[00:35:10] Speaker C: But it's become like the, like, these diets that are wrapped in some pretty bones. Like, no, no, I'm not on a diet. I'm just like, on this wellness journey. And sometimes that wellness journey can actually not be, like, what's most healthy.
And so I think that's very tricky because it's hard to identify. It's just like hey, I want to exercise more and I want to eat healthy and again those aren't bad things but it can so quickly be taken to the extreme.
I also think like and I don't know as much in college but I mean I imagine like we're also seeing a huge shift in ozempic and GLP1.
[00:35:43] Speaker B: I was going to ask what your take on this.
[00:35:45] Speaker C: Yes. And just like this, this deep desire for weight loss and I could do a whole other show on this but I think there's. There' some benefits of GLP1s that we've seen in the research in regards to different health concerns. But I've also seen clients who are in a very normal appropriate body or normal size body who still are craving weight loss and so they're microdosing or they're getting GLP1s from like non authentic store things that are just a little scary.
So I again I don't know fully. I don't have any data around what we're seeing on clients.
[00:36:19] Speaker B: It's hard. Well, I can think of one student I had in the last year who when you just first started hearing about Ozempic and she came in and started, told me that she was going to start that and I didn't know really how to respond to that. I really thought kind of like you like is this another form of an eating disorder? Like how do I label this in my mind, you know?
[00:36:48] Speaker C: Yeah, yeah.
[00:36:49] Speaker B: Because I felt like just what you said, I felt like she was using it for the wrong reason reasons. I don't know any other way to say that.
[00:36:55] Speaker C: And I mean I can get on my soapbox here but there or it's a desire to achieve something by being thin that's probably not going to be achieved by being thin.
[00:37:05] Speaker B: Well, it's like deeper. It's like what you said at the beginning, it goes, it goes way deeper than just the food.
[00:37:10] Speaker C: Yep. And so I lose weight and all of a sudden I still don't feel like I fit it, you know. And so I think that's where again the work is much deeper and takes more therapy and understanding of yourself yourself that weight loss is not going to likely lead to you kind of achieving all those goals.
[00:37:26] Speaker B: You mentioned social media. I mean this could be a whole nother show too. And we, I have had shows about the detriment of social media but in particular I can with the eating disorders because I can remember when you probably can too remember when websites used to like there Used to be websites specifically for people like teaching.
I can think of one right now. I'm not going to say say it.
[00:37:49] Speaker C: Yeah.
[00:37:49] Speaker B: But I was just appalled at that. Websites, basically, in case you're listening, you don't know they would teach people how to have an eating disorder.
[00:37:59] Speaker C: Yeah. And there are things like that that still exists. However, again, it's scary because now we're seeing it, like I mentioned earlier, like inspiration. It's like we're seeing it mass in a way that doesn't feel as detrimental on the outside, but really it's doing the same thing.
[00:38:14] Speaker B: I think so too.
[00:38:15] Speaker C: And so I think it's almost scarier because you don't even really realize it until you're kind of deep in, um, and younger and younger are getting social media. And so then we're seeing it start way earlier than we did 10 years ago.
[00:38:27] Speaker B: What are the first signs?
[00:38:30] Speaker C: Um, I. I feel like.
[00:38:35] Speaker B: As like.
[00:38:36] Speaker C: A very blanket statement. Like I see. I often see a lot of withdrawal.
So that being like.
[00:38:43] Speaker B: You mean from social situation, really. Okay.
[00:38:46] Speaker C: And it could be like I mentioned earlier, it could be like, like I don't want to go out to dinner because I don't want to have to navigate not ordering anything or getting the side salad with no dressing, or I don't want to go. Or like I'm so distressed in my body that I don't want to be around people. Obviously I mentioned the irritability, the low mood. I think there can be like even some increase in social anxiety as it relates to being around food, talking about food being in our bodies.
I think, I think that unfortunately a lot of the physical symptoms come way later.
So if you see like weight loss or potential like brittling of skin or nails or hair, like that typically is going to be those. Those symptoms aren't going to come until typically later on. Which is why it's scary because someone.
[00:39:32] Speaker B: May not even scary because then it's like a while. Yeah, yeah, yeah.
What about how, how do you help students rebuild, build trust with food?
And I know that is probably. That is a long discussion. Yeah. But if you can, you know, as far as like in the dining halls even, how can they rebuild trust? And with the group meals like you talked about, going out with their friends and you know, unpredictable schedules, holidays even, how do you start to help them rebuild trust?
[00:40:07] Speaker C: Yeah, you're right. This is like the, this is the bulk of the work.
[00:40:12] Speaker B: It's a lot over.
[00:40:13] Speaker C: Over three or four months. But I think, I mean, understanding the why, like understanding why the Trust was broken in the first place comes to mind. So, like, what are these beliefs that you have around food? And we can usually, I mean, it's. It's not as easy as this sounds, but we can combat some of those beliefs usually two ways. One is like, through psychoeducation. So let me explain to you actually what a calorie is versus what your eating disorder has made it to.
Then the second thing would be we get these beliefs from somewhere, right? We heard a coach say it, we saw it on social media, or we had a friend. Like, the beliefs also come from somewhere. So we can also, like, tease out. How did donuts become bad? Oh, when I was six years old, a friend made fun of me for having two donuts. You know, we're both doing the, like, the brain, the psychoeducation aspect, but also that deeper work of like, unlearning some of those maybe maladaptive or misunderstood beliefs.
[00:41:15] Speaker B: It's almost like deprogramming.
[00:41:16] Speaker C: Yes, that's a great way to put it. That's a great way to put it.
And then I think there's a balance you mentioned. Just like, I mean, college and food is so unpredictable. Like, there's anything about food in college. It is so unpredictable. And I think there's such a balance because with someone who's healing from an eating disorder, like, structure is actually really helpful to kind of know, like, okay, I'm going to have this for breakfast. Like, there's a plan in place. It can decrease some of the anxiety. So I do think it's a balance between where can we create structure? So can we have certain groceries in our dorm that we know that are safe and that we can eat and we know how to portion them. But then how do we also plan for the unpredictable?
And how do we talk through, like, okay, something unpredictable happens, your anxiety increases. Like, how do you take a minute to ground to come back to be able to engage in something that's unpredictable? So I do think it's paired with.
It's kind of paired with both the, like, making a plan, creating structure, but also processing through or like pre planning how we're going to respond if something doesn't go as planned?
[00:42:23] Speaker B: How do you.
How do you deal? Or I don't know how to ask this list. How do you. You handle or cope or teach family members who are skeptical? Because I know there are family. I mean, I have students come in that say things like, my parents don't. They'll literally say, my parents don't believe in mental health.
So how do you deal with.
You've got a student, you've got a young person who is willing to come into treatment, but their family, who should be their support are. They're just skeptical. They're like, she's making this up, up. Yeah, he doesn't want to eat what, you know, we cook, so that kind of thing.
[00:43:05] Speaker C: Yeah, yeah. I mean, education, Education.
[00:43:08] Speaker B: I know.
[00:43:09] Speaker C: It's just kind of as much as they're willing to hear it, just continuing to offer them the education and then also working with the client, like, what would it, like, the react. The reality may be that your family never changes, and that's really hard. And I want to, like, help a client to grieve and work through that. But just because their family won't change doesn't mean that they don't deserve recovery. So I think there's an element of, like, I want to hold hope that every family can come around and offer the support that needs. But there are a lot of families who can't. And that's their own work.
[00:43:40] Speaker B: They.
[00:43:40] Speaker C: They probably need to go to therapy to work on that themselves. But that's not my role as, like, the provider of the client. My role in supporting that client is to say, how do you keep living and you keep working and find. What other support can you find while your family is able to kind of do their own work? Because a lot of patients will feel like, I can't change until my family changes, which is not. It's out of their control. And so that's not fair.
Yeah. And so. And then it's kind of that. A little bit of a grieving process of, like, how do I allow myself to heal even if my family is not.
[00:44:13] Speaker B: How does alsana involve the family?
[00:44:15] Speaker C: Yeah.
[00:44:16] Speaker B: Groups or individual. How do you involve the family?
[00:44:20] Speaker C: So through a couple of different avenues. So we, we recommend every client have a supportive other session weekly. And this doesn't have to be a mom or a dad. It could be. Be a friend or a roommate or a coach. I mean, family. Family looks different for everyone.
And so that is typically in. The purpose of that session really is psychoeducation. We're talking about conflict revolution, resolution. We're talking about eating disorder 101 communication, that sort of thing.
So we offer that, and that would be with the primary therapist, the client, and the loved one.
And then we also offer.
We're actually starting in December, which is really exciting, what we call family intensives. And so they are like two every month that are like kind of intensive family work. So we offer a psychoeducation group that's just for families.
We offer a processing group that's just for families. So let's process what it's like to have a love disorder. We all. We offer a processing group with the clients and their families all together. And then we offer a meal where like, the clients and families can all eat together. And then a kitchen group where we're usually like baking or cooking something in the kitchen. So that's a pretty. We used to. To do what we call family weeks. Pre Covid. And then Covid hit and everything changed. And so this is our resume. And we'll do these both in person and virtual. So it'll be a lot of. A lot of psychoeducation and support.
Families need support. And it's really cool sometimes when family members of different clients can get to know each other and realize, like, oh, we're experiencing the same thing.
So that's what we kind of have coming up in December, and we'll do that every month.
[00:45:59] Speaker B: Do you have a cap on the numbers on how many people can be treated?
[00:46:03] Speaker C: Yes. So it depends on the facility. Like, for example, in Birmingham, we treat up to 12 in residential and 12 at our PHP IOP in virtual, we have 40 to 50 clients. We don't really have as much of a cap in our virtual program. And then our California locations, we have some facilities that are six bed and then some that are 12.
[00:46:23] Speaker B: So a little bit smaller.
[00:46:24] Speaker C: Yeah, Groups typically don't go above 12 clients.
[00:46:28] Speaker B: The other question that somebody else sent in via email had to do with arfid. We've already talked about it, but the question is, how do you approach helping a college student who is struggling with arfid? It's the same. It's still the same treatment, right?
[00:46:41] Speaker C: It is the same. So it's still kind of assessing the underneath. And there's a lot. There's usually a lot of anxiety with arfid. And so really looking at the anxiety and the grounding and containment, the only thing that I would add is just the treatment of ARFID is exposure. And so if someone's at Olsana and struggling with arfid, every session is exposure. And we do that with all clients of all diagnoses. But with arfid, it's kind of all that we're going to do because that's kind of the erp.
[00:47:07] Speaker B: More variety basically of the food.
[00:47:09] Speaker C: And so we would do that like in session. But then we would also encourage the client to try that on their own. And it would be like A slow process of increasing the number of foods that they are getting.
[00:47:20] Speaker B: Yeah, I hear you. Let's take our last break. When we come back, I've got some more questions, especially for particular students who might be listening that want to know what's the first step. So hold on to that thought. We'll be right back. You're listening to brain matters on 90.7, the capstone.
[00:47:45] Speaker C: Wvuafm Tuscaloosa.
[00:47:47] Speaker A: This show is not a substitute for professional counseling and no religious relationship is created between the show hosts or guests and any listener. If you feel you are in need of professional mental health and are a UA student, we encourage you to contact the UA Counseling center at 348-3863. If you are not a UA student, please contact your respective counties crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
[00:48:26] Speaker B: Hey, you're back listening to brain matters on 90.7, the capstone. I'm Dr. B.J. guenther. We're talking tonight about Alsana.
Alsana is a treatment program based in Birmingham. Inpatient and outpatient, offers all kinds of services if you have a needing disorder, if you know someone who's struggling with an eating disorder. Katherine Jordan is the director of nutrition services for Alsana. It sounds like a big job, Catherine. I mean, it just sounds daunting because to me, when I hear about eating disorder, nutrition is the first thing I think of sometimes even more than medical, to be honest. So that, that's, that's amazing. The. I didn't realize, I don't know if, you know, I've had to refer people to treatment programs before, but usually you refer and then you don't hear any, anything else. They're, you know, they take over and you're, I would be out of it here at the counseling center because we don't do, we're a brief counseling center, so we don't do really intensive long term treatment here for somebody who might be listening and feel embarrassed or afraid to ask for help. Like, what's the first step they should take?
[00:49:33] Speaker C: Yeah, I think, I think there, there are kind of two options. We talked about it earlier a little bit. I mean, my first recommendation would be is there someone that you trust and even if you can't disclose all the details, this could be a roommate or a professor or a coach or a parent. It could really be anyone. And I say that to reiterate. Eating disorders are secretive and they're shame disorders. And so sometimes even telling one person can decrease the shame to allow, to kind of open up your opportunities to be able to share with other people. But another option. So on our, on All Sauna's website, we have like a 24, 7 live chat. And so if you're like, hey, I don't want to tell anyone, I know I don't trust anyone enough to tell them, but I want to tell someone.
The live chat is available and it could even connect you with resources or if you think you need treatment, it could kind of connect you with that. So those are kind of two very different options, but both are there to potentially be able to like find a way or like that first step.
[00:50:33] Speaker B: How do y' all partner with universities?
[00:50:35] Speaker C: Yeah. So if we have a student that's in our care. Well, let me start. We do things like this, right. Like I am often, I'm often coming to university and talking.
Yes. Presenting different things like that. And so that's one way. But I think from a more tangible standpoint, if we have a client who's in our care, if we have permission from the student, obviously we really care about collaboration because what we have found is that we're only a blip in someone's recovery journey. We're only 30 days, 90 days, and really wherever they're returning to, so whether that's home or something, school or their primary care provider, you know, who is going to be their team once they leave us. So we typically send weekly, again with the client's permission, like weekly updates. But also we really want to collaborate. So everything from, hey, is there a way to get the dining hall menus for next week? Or is there a way that we add a client in virtual that lived in a dorm in the same room and she had nowhere private. We require you obviously be a private space to program virtually. We talked to university, they said, oh, no worries, like we can reserve this room at the library every day for this client. And so little things like that. I also.
[00:51:50] Speaker B: A lot of collaboration.
[00:51:53] Speaker C: Yes, absolutely.
[00:51:54] Speaker B: Wow. That's, that's, that's a starting point. That's good.
[00:51:57] Speaker C: Yeah, absolutely.
[00:51:59] Speaker B: What about parents? Like, what should parents know about their college age child? You know, and if they're showing any signs like, you know, if they're away at school, that's kind of hard sometimes. That would be hard to know.
[00:52:16] Speaker C: Yeah. What I often see come January I get a lot of call from parents because I think, oh, because they're home, they come home for winter break and parents realize like, oh, they've lost weight or they are withdrawing or they feel more irritable.
I mean, my advice is always going to be, be like, just say something. And there's a way to do it very gently and very genuinely. And as I mentioned earlier, how are you sleeping? How's your stress? How are you eating? Like, do you have enough money for food? Like, there's ways to ask it all together.
[00:52:48] Speaker B: Yeah. Yes.
[00:52:48] Speaker C: That are not like finger pointing, like, are you eating enough?
But I feel like there definitely is. I think the approach has to be more from a curiosity standpoint than an accusatory standpoint that would allow for their loved one to open up.
And then I'll repeat again. There can sometimes, sometimes be like a not great reaction at first, but to allow the parent to, like, obviously remain calm and patient. Because often, like you mentioned earlier, bj, often it is a relief. It just takes a minute to realize, like, okay, someone's noticing I need help.
[00:53:22] Speaker B: Well, and they're scared, too, because I think it's just like a student who's having thoughts of harming themselves. Sometimes they don't come to the counseling center because they think we're immediately going to put them in the hospital. And that's not true.
It just depends on the situation. So I would think someone who's struggling with an eating disorder would be terrified that if they say something, they're going to have to go into inpatient treatment. And that's not true.
[00:53:46] Speaker C: No. Hopefully if they say something early enough.
[00:53:49] Speaker B: That's right.
It'll be early enough.
[00:53:52] Speaker C: When we wait too long and we're in too deep is when, you know there are kind of like higher levels of care that are needed. But it could be that if you share your struggle, like early enough with someone, you can get set up. Yeah. With the counseling center, with a therapist, with a dietitian and be able.
[00:54:06] Speaker B: Or with virtual nutrition. Virtual, Alana?
[00:54:10] Speaker C: Absolutely.
[00:54:11] Speaker B: Okay. So if you. I want to. I want to make sure we talk about this. If you could communicate one message today to college students struggling with food or body image, what's that message going to be?
[00:54:25] Speaker C: I think the first thing is that you're not alone.
I actually think, I think that, like, I think if someone tells you they've never, never struggled with body image, they're probably lying. And it's because of the society we live in. And I'm not going to fall any one person. It's just the way of the world.
But I really think if you are struggling, I'm repeating what I just said, like, to please share with someone because Again, early intervention is key because that actually we see that that is like the best predictor of full recovery.
8 and eating disorders are serious, and so things can get bad a lot. And no one wakes up and decides they want to have an eating disorder. So I will also share that it is a mental health diagnosis that it's beyond just like, oh, I decided not to eat today. And now it's much deeper than that. And so I think there's sometimes this belief that, like, I can just will my way out of this, I can fix it myself. It's not that bad.
But in reality, I, I think there's such power and there's such freedom in, like, sharing what you're going through and because really, like we said, it's all what's underneath. And so being able to process that with a therapist, with a dietitian, even with a loved one, like, can be really powerful in preventing someone. I mean, I have clients in their 60s and 70s and I. It breaks my heart that they've been battling this for 20 years.
Yes. To think like, hey, if college students can, like, seek the help that they need quickly, then they can heal and hopefully to move on with their lives and not have to be in and out of treatment at 60 and 70 years.
[00:56:01] Speaker B: Well, when you mentioned that, when you said, you know, you're not alone, it's true. And I can remember when I first started the show, I think the first year I started the show, I had Ms. University of Alabama at that time on the show to talk about her eating disorder. And that is a big deal because sometimes when people hear someone who has what they see as success, successful, has struggled with an eating disorder, that might be the encouragement they need. I can remember the. I think one of the last shows I did about eating disorders, solely about an eating disorder was with a.
A male college, a baseball player here on our team. And you could go back and listen to that if you're interested. But I know it's a low percentage of men who struggle with eating disorders, but it. They.
[00:56:49] Speaker C: Yeah. And you asked earlier, like, what trends we're seeing. And that's definitely a trend we're seeing. And I don't think, I don't think more men are getting disorders. I think more men are seeking help.
And we treat male and female at Alsana. We treat all genders. And so I usually, at any given time, I have at least two male identifying clients in our care in Birmingham. So it's really, it is very much. I mean, we're seeing more and more of that for sure.
[00:57:14] Speaker B: Lastly, where can listeners go to learn more about Alsana or if they want to get help or if they want to talk. You mentioned the live chat but mentioned some other resources. Yeah.
[00:57:24] Speaker C: So our website is like a plethora of information. It has blog posts, it has our admissions line, it has all of our locations, the states that we're licensed in and virtual. It has so much good information but in also. So that would be my number one recommendation. But also the National Eating Disorder association website also has some great resources if you just want more general information.
But OSANA website would be kind of your one stop shop.
[00:57:49] Speaker B: It is a fantastic. Oh yeah, it's a great website. I don't think every question is answered just about.
[00:57:55] Speaker C: Yeah, yeah.
[00:57:56] Speaker B: Hey, thank you so much for being on the show. I say this every week, but it really does go by fast when you got something interesting to talk about. And I have so many more questions that I didn't even get to, so.
But you, you did great. Yeah, we probably that wouldn't hurt, you.
[00:58:10] Speaker C: Know, I'd be down at least once.
[00:58:12] Speaker B: A year, you know. So thank you for being on the show. Let me make a few announcements and we'll go. Don't forget our shows are recorded and podcasted on the Apple Podcast. Go to Apple and subscribe to our show, please. That would help us out a lot. Also, we're on audioboom.com and Voices Ua Edu. Voices Ua Edu. You can just type in Brain Matters and find some of our past shows. You can also find it Voices UA Edu at our counseling center's website, which is counseling.
I like to thank a few people who've made the show possible. Our executive Director here is Dr. Greg Vanderwaal. My colleagues here at the counseling center, of course, my producer, Katherine Howell, who'll be back next week, Gareth Garner. He is the student who edits our shows every week. He does a great job. The WBUA staff and of course my guest tonight, Katherine Jordan. Don't forget, next week will be own and the topic is Hope as a Strategy for College Students. It'll be a very fascinating and interesting show. I'm excited about it. So tune in next week and again, thanks for listening. Have a good evening. Good night.
[00:59:28] Speaker A: This show was not intended as a substitute for professional counseling. Further, the event, views, opinions and conclusions expressed by the show hosts or their guests are their own and not necessarily those of the University of Alabama, its officers or trustees. Any views, opinions or conclusions shared on the show do not create a relationship between the host or any guest and any listener, and such a relationship should never be inferred. If you feel you are in need of professional mental health and are a UA student, please contact the UA Counseling center at 348-3863. If you are not a UA student, please contact your respective counties crisis service hotline or their local mental health agency or insurance company. If it is an emergency situation, please call 911 or go to your nearest emergency room.
