WMH Season 4 Ep 14: Is Diet Culture Ruining Your Mental Health?

This is a transcript of Watching Mental Health Season 4, Episode 14 which you can watch and listen to here:

Katie Waechter: Hi everyone and welcome to another episode of watching mental health. And I am so excited because today we have somebody who's truly an expert and in a subject that is hard to come by. And with that, I wanna talk to you a little bit more about Leslie Schilling before I introduce her, bring her on the stage. Leslie is a master's level registered dietician and she specializes in disordered eating, sports nutrition, family nutrition, weight concerns. And she's worked across many different settings, including nutritional settings, acute care, outpatient, adult and pediatric weight, as well as in recreational professional sports trainings. She's a member of the International Association of Eating Disordered Professionals and the International Federation of Eating Disordered Dietitians, ⁓ as well as the American Sports and Performance Dietitians Association. And she really is a specialist in sports dietetics and as also the only certified eating disordered registered dietitian and Supervisor Consultant here in Southern Nevada, which is a huge deal She's worked with elite athletes Olympians performing artists and was also the sports nutritionist for the NBA Memphis Grizzlies and today on watching mental health we're gonna talk about how diet and nutrition impacts mental health and we're gonna talk about eating disorders and where support is and how you can seek support if you're that's something that you or a loved one is struggling with. And so with that, welcome to the show, Leslie!

Leslie: Thank you, I'm glad to be here!

Katie: So excited to have you here. Like I said, I just don't get the chance to talk to too many experts in eating disorders, as well as somebody who also has just the experience that you have with nutritional coaching, education, just your background is so impressive. I'm just really grateful to have you here. I just want to start off with what I ask all of my guests is, tell me a little bit about what brought you here this line of work and why you're continuing it on this, to today.

Leslie: Yeah, yeah. So I usually say the drawl is from North Carolina. So that's where, so if you hear that, that's, I grew up in North Carolina and I grew up ⁓ in the central part of North Carolina, like, you know, playing outside and running with my dog and, you know, just, just really enjoying pre social media life and you know, growing up and that led me to kind of a life of athletics. And so I was a gymnast growing up. I was involved in track and field and then ended up at Appalachian State University in the mountains of North Carolina to pursue. I did an undergrad and a master's degree in nutrition and my master's degree was ⁓

Also, there was a heavy emphasis on sports science and exercise science. so I was really, really lucky to kind of fall into this sports nutrition piece through my master's program. And then I ended up doing sports nutrition research at the University of Memphis for my first job. And I was heavily sports nutrition. Like I'm Leslie, I'm the sports dietician, this is what I do. And then someone from the church I was currently attending reached out and said, I want you to help my daughter. She has an eating disorder. And I'm like, I don't do that. I don't do eating disorders. ⁓ And she's like, listen, she's an athlete. And I think the only thing that will save her is the love of her sport. Would you take her own? And ⁓ I learned right then, you can't be a sports dietitian without a pretty secure knowledge of eating disorders and just one, being a dietitian in our culture too. And I quickly ordered every book I could think of and ⁓ got, luckily got taken under the wings of some really seasoned and lovely eating disorder therapists who then started a supervision relationship that lasted over 10 years. ⁓ And so I was in part of a supervision group of mental health specialists who worked with people with varying issues, but particularly eating disorders and they trained me. And they trained me ⁓ as a dietitian. So that's why like if you look in my bio, I'm a performance dietitian, but I'm also a nutrition therapist. And so what dietitians do, ⁓ their actual procedure code is medical nutrition therapy. So I like to say we bridge the gap in between.

Katie: Wow.

Leslie: Medicine, nutrition, and therapeutic approaches. We're not therapists, we're not doctors, but we do have a broad knowledge that dips into both of those areas. And so I started a practice in Memphis, Tennessee. I was there for 15 years. And it was a specialty practice in eating disorders and sport. And then I moved to Las Vegas in 2016. So I'm not fresh anymore.

I've been in the desert now for ⁓ 10 years, yeah, and have a small private practice here and I spend a lot of time supervising, I'd say at least half of my time as supervising dietitians that want to work at this intersection ⁓ and feel like they didn't get enough training in terms of the eating disorder piece ⁓ when they were going through their own programs. So, and that's me, that's what I do now.

Katie: 10 years in, yeah. Yeah. That's amazing. ⁓ I like that you touched on a few things. First, I was gonna ask, what is that difference between a dietitian, a nutritionist, a nutritional therapist? And you kind of touched on that a little bit, but explain it a little bit more and yeah, how those intersections come together.

Leslie: You know, it's a different state to state. In this state, you have to be a licensed dietitian to practice to do medical nutrition therapy. And that would be like if someone has a diagnosis of some sort and you're helping them with their nutrition related to a diagnosis, you actually have to be a licensed dietitian. A lot of people don't know that. And then people will call themselves a nutritionist. And you don't really need any credentials or education to call yourself a nutritionist. So I will say the two different things, but my professional credentialed title is a registered dietitian. And so you know a registered dietitian ⁓ now are having to have master's degrees too. So they've had a very high level of training. A year, almost a year for many people of internship and residency and then they set for a national board exam. And so, but if you possibly are working with someone who calls themselves a nutritionist without, we don't know that they necessarily have the level of education for that. And then once we get, you know, our RD credential, then we usually specialize. There's some generalists out there and I started out that way, but some of us find kind of our love areas and really niche down into that area, which is where I'm at, at kind of that intersection of active populations and eating disorders.

Katie: Yeah, that's amazing. I wanna get into a little bit around mental health and dietitian, or, you know, as well as around sports. But before I do that, here in the state of Nevada, do we have very many registered dietitians? ⁓ It doesn't, it seems like something that we should have more of, but it feels like it's hard to come by this, like your level of expertise.

Leslie: You know, there are a lot of dieticians in Nevada. And again, remember, people kind of pick their area of expertise. And so if you want someone who's probably, ⁓ you know, understands more of the mental health side of that, that would be a question to ask if you, you know, called their office and just said, hey, I'm just curious if you're aware of the mental health piece. But if you want someone who's really aware of disordered eating,

Katie: Aha, okay.

Leslie: What's happening in diet culture, is our just broader culture that's obsessed with thinness as a means to health, which is false. And then, ⁓ you know, if you want to kind of test the water to see if you've got somebody who kind of understands this area, I would ask them if they practiced, you know, do they understand and use an intuitive eating approach, which is an evidence-based, ⁓ you know, self-care framework that many dieticians are trained and some are certified in. You can find people who are trained but not necessarily certified. And if someone understands and practices with an intuitive eating approach, they're gonna have some knowledge of how mental health plays a role. They're gonna have a knowledge of disordered eating. ⁓ You could even look for credentials of someone who has a SEDS, which is a CEDS, which is a Certified Eating Disorder Specialist, and that's across disciplines. ⁓

But it's a really, really hard credential to get. ⁓ But there are still a lot of other providers out there that have a level of understanding that might not carry that.

Katie: Okay, that's interesting. That's really good to know, actually. So, good tip. So, let's talk a little bit about diet and nutrition and mental health. And then I do want to talk a little bit about sports next, because I think that's also really interesting, and I'm sure you've seen a lot in that realm as far as sports and mental health. But before we get into that, I think that it's become more and more common knowledge, right? That what I put into my body does impact my mental health, and certain foods or certain types of foods may have a behavioral effect for me or even my loved ones or children, right? I know that children tend to have, ⁓ I think, higher reactivity to maybe foods that are put into their body. So talk to me a little bit about that. ⁓ Just, you know, maybe has the culture from what you've seen, has it improved? Are we talking more about these things in a way that we should be? ⁓ And, you know, just talk to me a little bit more about kind of what you know around mental health and how that's impacted by diet and nutrition.

Leslie: I would say to the answer of like, we doing better? Are we talking about that? I'll say the answer is yes and no. It's always, it depends. ⁓ So what I have found, like I will say when I was like a baby dietician, it was like, let's eat this way, do this, a lot more structured. And then as I've become, you know, I feel like I've done a lot of unlearning and relearning and like learning is one of my values. And so,

Katie: Okay, okay. Sure.

Leslie: As I've done this learning and supervision and unlearning over the years, I've figured out that there is one major component or there are a lot of components, but there's a primary component to mental health and that's enoughness. And I think what we spend a lot of time focused on, I need more omega threes or which is great, fine, go for it. But, we're like really nitpicking ingredients and we miss the boat when it comes to your body doesn't really care about all those specific ingredients when it's fighting to have enough. And I think it's important to talk about what diet culture is and how that impacts your mental health, because I think that's what most people are struggling with on a, like on a superficial at first glance ⁓ kind of issue, what somebody would bring to the table. And diet culture is a system of beliefs, some would say a system of oppression, that falsely elevate certain bodies and certain foods as a means to health. so, know, bodies come in all different shapes and sizes and health comes in all different shapes and sizes. And we live in a culture, particularly now, with lots of focus and I will even say predatory commercials and marketing about weight loss medications.

But we live in a culture now that tells us that thin is health and eating less is healthy. And those are, they're both really missing the mark. And it makes people worry about how much food they eat, which usually sends people to my office. And I'm sitting there saying, I think you get okay variety, but you don't get enough food, period. Like you don't get enough food because you're afraid to eat because our culture has made you afraid to eat.

And so that then triggers anxiety around food, anxiety around body. All of these things happen when we're underfed. ⁓ And so the first thing I would do for someone who's coming in really concerned about their mental health would be to help them get on a more ⁓ structured and not spreadsheet, not militant, but like, let's make sure you're eating consistently adequately and let's see how you feel. Let's make sure you're getting adequate sleep because if you're not that's going to impact how you make choices about your food later on. Let me help you understand that genetics plays a really big role in your body and your body size and chasing a number on the scale might be harming your mental health. And so we do a lot of let's talk about what the culture is doing to you and how much of that you want to take with you and how much you want to let go to maybe have a little more peace around food and body. And are you willing to feed your body adequately? And if somebody then says yes and we do that and we've worked on that, then we might work on, you, you know, like somebody might say I want to eat a little bit better. Well, what does that look like for you? And they're like, well, I don't really eat a lot of fruits and vegetables. And one of the reasons they don't eat fruits and vegetables is because they don't like to buy them, cut them and prepare them.

And so part of what I do is I say, you know, it's okay if you buy a bag salad. You know, I'd rather you eat vegetables or eat fruit that has been cut for you, if that's the limiting factor, if you can afford that. I'd rather you do that to add variety. And as you feel more proficient or as you feel like you have more time and energy, to do some of these other tasks related to getting certain types of food in front of you, that's wonderful. But it really, ⁓ I try to help people take the rules away from eating to have a little bit more peace around it. And that plays a huge role in ⁓ mental health. So like, of course we can like add more salmon if you want, know, a mega fats. There are a lot of things we can do, but the foundation is adequacy.

Katie: Okay. That is so interesting. love that perspective. ⁓ I hadn't thought of it that way, but it's really, really true. First off, I like how you're saying that I'm gonna meet people where they're at, right? If they're not in a position where they can cut up their own fruits and veggies comfortably, but they wanna try to incorporate more, then okay, then buy some freshly cut vegetable and start there, right? I think that's beautiful, but thinking about it, I think you're absolutely right. It's really a yes and no. In some ways, yeah.

We are aware that more foods like salmon, right, will have a good impact in this specific way. But on the other side of that, you know, if we're taking too much detail, if we're missing the forest through the trees, right, if we're jumping into too much, and I always like to say, you know, I hate to say I'm on a diet because to me, that means I'm gonna end. That means there's an end game to that diet. So it's like, okay, let me count all my calories and spreadsheet this out for my diet period.

Leslie: Right. Right.

Katie: Instead of just fundamentally kind of changing my relationship with food, which is your approach, I think that's so cool.

Leslie: Yeah, well thank you. Well listen, and it's pretty freeing too. mean, and I think a lot of people don't realize that that's even an option because in your eighth, ninth, tenth grade health class, you do a project that's counting calories. And if there are any teachers out there listening, you know, like if you have any say so in your curriculum or syllabus for the year, please don't do that. It is so, so triggering for, and I know that teachers are doing the best with what they have to You know, the check boxes they have. ⁓ But like I send notes to teachers for my clients that are like, hey, we need an alternate, you know, an alternate assignment because counting calories is really not that helpful for you. But if somebody's really stuck on that, right, and say they're having a really low amount of energy, I will meet them where they are if they can't get away from the numbers and say, well, let's talk about what that really needs to look like. And it's never lower. I can tell you that.

Katie: Sure.

Leslie: It's like, you know, it's like, let's go higher. Let's have a better breakfast. Let's, you know, legalize the foods you're afraid of.

Katie: So that's... right. No, it's interesting because it's like the opposite of what we're busy reading, right? We're like, if I want to lose weight and be healthy, then I need to count my calories. I need to take in less than I'm putting out. And there's this battle. And it's almost like it's not even accurate. And every year it changes anyways, right? This year, this diet is better for you. And this year, this diet. And it's hard to keep up.

Leslie: Right. Protein and everything this year.

Katie: You

Leslie: That's right. And it is there's so much marketing and misinformation and social media adds a whole new element of misinformation to the mix. ⁓ And it's just and we have like, unfortunately in diet culture, we have this very ⁓ unacknowledged privilege of, you should just eat those raspberries at six dollars a cup. Well, if somebody says I have to eat something at six dollars a cup and they need to feed their family, they're not buying a cup of raspberries. And so we really demonize and we don't think about the true expense of food. And you'll have people say, well eating healthy, I'm using my air quotes, is really not that expensive. And I'm like, well sir, yes it is sometimes. And we really have to do the best we can to ⁓ meet people where they're at. I work with clients that have a very low food budget and we're buying frozen veggies because they're frozen and they're cut and frozen at the peak of freshness. They're cheaper, ⁓ they're easy to use, they have a great shelf life. We can use canned, can use low to no added sodium. There are a lot of things we can do to add things in a lot more economically, but because our culture is like, food TV approach to fresh food is the only way, people are like, I'll never reach the bar. So they don't try. So we really, like I have a habit of saying in my client sessions, I'm like, can we lower the bar here? I say that a lot, can we lower the bar? Because if we lower the bar, you're probably gonna realize that you can incorporate things that.

Katie: Mm-hmm. Yeah.

Leslie: You know, aren't the most expensive, that don't require the most amount of work, until we get you to a place where, like, I'm a registered dietitian who has an economic ability to go buy some of the foods that I want. And I'm still not gonna cut a Brussels sprout. I'm gonna buy it pre-cut. And that's okay. So it's like, it's okay to do the things that get people closer to...

Katie: Yeah. Right.

Leslie: towards what they want to do or how they want to eat without, there's a lot of shame involved in food and how we eat and we try to remove that. I'm like, if you like a cupcake, eat a cupcake. One food is not going to make or break your health at all, you know? But you try and not to eat the cupcake and then you just ate a bag of, I'm using my air quotes, healthier cookies or whatever. I'm like, I wish you would have just had the cupcake and had like this delicious moment with it and moved on.

Katie: Right. Okay. Thank Right, and moved on, exactly. Yeah, it's like you avoid the cupcakes, so you go and you eat, yeah, the whole bag of cookies and five crackers, like you're trying to make up for it.

Leslie: Yeah. Yeah. Yeah. afraid of food is far more detrimental to your mental health than having a varied amount of food and peace with the food that you eat.

Katie: Wow, wow. That's so interesting and really just a good way to, I think, start looking at food. So let's talk a little bit about sports. And so you work with athletes, right? And now you add this intense sports into the mix. And there's probably this idea of athletes, I need to look a certain way or I need to be a certain weight. And maybe for certain sports there is like a weight requirement or a weight aspect to it. But I think just in general, the amount of our our elite athletes, the amount of mental health, you know, problems that they may experience that we're only now as a society discovering in so many ways like that intense pressure has to be so hard on them and their relationship with food. And so talk to me a little bit about that and your experience around that.

Leslie: Mm-hmm. You know, I will say that it doesn't matter how elite someone is, ⁓ the impact of diet culture gets them to. So we have to do, you know, when I'm working with a really high level athlete, you know, I ask like, what are your food beliefs? Like, what do you believe health looks like? What do you think health behaviors are? ⁓ Where did you learn some of this? ⁓ You know, are you open to another perspective? I say that a lot because we have to be, I think.

Katie: Yeah, right.

Leslie: And you know, and then are you open to fueling your body at a level that will be optimal and optimal often even for elite athletes looks like more than what they're used to if they hadn't already had some adjustments with, you know, another sports dietician or a performance staff that they work with with their teams. ⁓ And so it really is helping them understand like you need a lot of energy to do your

Katie: Mm-hmm.

Leslie: Sport which is your job as a professional athlete you know. ⁓ You need a lot of energy to do that and you don't just need it to do that you need it to be a human. You need it for your brain to function, you need it for your guts to function, you there are a lot of things you need it for hormone functioning you know no matter what type of athlete that you are. And it's really easy to to engage and let's say we're talking about a high school swimmer and they're doing two practices a day. They're doing a land practice, they're doing a water practice, they're also doing conditioning. They also have homework. They have, you know, or you've got somebody training for a marathon, very similar training. They've gotten their information from Diet Culture, which is like, let's say 2,000 calories or something like that, right? Not that we want to count calories or put those numbers out, but just for them to know that that's, that has not been appropriate for anyone in my office, I'm just saying.

So you've got them getting information from apps that say this should be good or good enough for you when there is no way that's optimal fueling for this very active person. And I will tell you it's usually not optimal fueling for a moderately or low active person too.

Katie: Right.

Leslie: We need a lot more energy than we think we do and we can have a strategy around it. Especially with you, you've got athletes are like, but I don't feel like eating after here. Then I'm like, okay, well then we eat more through the day with our meals. And then maybe we do some more liquid nutrition post training or post game to help you not get behind in terms of recovery. So a lot of strategy that goes into it.

Katie: Right, wow. That's really amazing. ⁓ And have you seen athletes struggle with eating disorders or with disordered eating because it seems like there's so much misinformation for them in particular, right? They're really hyper-focused on it sometimes.

Leslie: Right, and yes, and athletes are at greater risk for developing eating disorders, especially those in aesthetic sports, like it might be ⁓ gymnastics or swimming or diving, you know, there are a lot. And it's also, remember, we have this macro culture that is diet culture saying falsely that then is health, and that's not necessarily the same thing. ⁓ We've got that macro culture, and then we have the disordered the disordered information or traditions that might be in their sport, in their own sport or with coaching. And so we have to deal with it at a macro and a micro level and then help someone realize that like, yes, this is present in your sport, but here's what we need to do to help you feel good and feel well and it's gonna look different maybe than the person that you're sitting beside because like we don't know their history, we don't know what they need, we don't know anything about that person unless you're working with whole team then we can be like, okay, we're trying to get everybody's intake improved. But yeah, I've had professional athletes that have some pretty concerning disordered eating behaviors that have been sadly missed because a lot there are a lot of people in high performance that don't think that they're seeing disordered eating or that people can't make it that far while having an eating disorder. And if you go back and look at any of the news articles post the last two Olympics, you'll see that that's false. Yeah.

Katie: Yeah, yeah, yeah. I think you could make it pretty far with an eating disorder, right? And covering your tracks and just with any mental health, you can make it pretty far covering the problem until it becomes no longer coverable, right?

Leslie: You can, and yeah, you can. Right. Exactly. And it's like it works until it doesn't. That's what I people. You're like, this is work? I'm like, it works until it doesn't. We don't know when that will be, but it could be when you're standing on the platform in the silver medal round.

Katie: Yeah, and just like mental health, you you said ⁓ everyone's a little bit different, right? So you can't take the same 2000 calorie, this is what you do, ABC approach to every single person because our bodies are different, our heights are, everything about us is different, right? And so you do need to, if that is a struggle, to really take a more customized approach to your own journey and to your own health.

Leslie: Right, absolutely. And everyone is so different. Like what I might be working on with this person over here, we would not do with this person over here. And like I've even as in my journey of learning and unlearning, I went from like calorie in, calorie out focus. Now I realize that that's like not really how the body works. That's like, we're not, you know, math. So we're much more magical and wonderful than just math.

Katie: Yeah. We are.

Leslie: Right? so, then I went, you know, swung to where like, we can't talk about calories at all to coming back to sit, you know, sometimes I do have to meet people where they are. If they have a mindset of, you know, maybe they're really anxious and they want to make sure they're doing something a certain way and they're willing to increase their intake, but they don't know where to go. Then I would meet that person where they're at and say, well, let's talk about maybe a range of something we could play with to see if that meets your needs better. there was a time where I wouldn't do that, but sometimes we've got people that are really analytical and sometimes those numbers are helpful. And then I would say for them, on the flip side, most of the people I work with, we try not to do that because numbers have been really harmful for them.

Katie: Thank with that. Yeah, absolutely. I like that balanced approach and yeah, some people will respond better to a certain way. But you know, in this culture of disordered eating, know, as I asked that question earlier in the show, was like, oh, sometimes it seems like it's better. But you know, now we're in an ozempic world and it feels like everyone's trying to get thin with a magic pill. And I don't know if that's actually good. And I'm not sure if the people taking those pills if it's healthy for them in the long run. So I'm sure you have thoughts on the weight loss pill. It's fat, essentially, that we're in. It feels like everyone's like, ⁓ take a pill, lose some weight. And their approach to the pill is to not eat, right? That's what the pill makes you do. It makes you not hungry. And so is that helpful? I'm not sure. So talk to me about that.

Leslie: I do have a lot of walls. What I'm gonna put my disclaimer out there is like I am a I'm an eating disorder specialist and there and I do not fault people for wanting to be on these drugs the marketing is predatory the ⁓ weaponized compassion that these Companies are using to get people on it specifically to lose weight is I think quite unethical But there are a few

Katie: Okay. Yeah.

Leslie: You know, diagnoses out there where these medicines in much, much, much smaller doses are, can be really helpful for people. So I really try to check my bias of an eating disorder specialist that's waving every red flag I have, being so concerned and balance that with, there are some people that might have some diagnoses where this, and obviously it's been using diabetes for a long time at a much lower dose, right? So like, we're not talking about that. We're talking about using it solely

Katie: Right. Good example.

Leslie: To shrink yourself and to make the number on the scale lower. The problem is that's been sold as this is the way to health and what we're finding with the research is that might not be true. When people are like, I'm not hungry, it's working. But what's happening is you are not eating and it essentially shows up. If I were to screen you for an eating disorder, you would likely screen out for positively for an eating disorder. If you're like, well, I'm not eating, I'm not hungry, you know, all the, you know, lot of hair spalling out, I feel weaker. ⁓ but they might be getting like social praise, which happens in eating disorders too. Or they're like, I can't go to the bathroom. I don't feel like my stomach's moving. I'm like, that's also, that's also something we see in disordered eating and eating disorders. So

Katie: Wow, that's a big symptom.

Leslie: behavior. ⁓ So those of us in the eating disorder space are super, super concerned and have already seen it cause many, relapse ⁓ for people. But what we're not seeing are prescribers and there are probably some out there, but I'm not seeing this come through my office. We're not seeing prescribers screen people for past history of disordered eating. We're not seeing referrals to mental health. ⁓ You know, we're not… we're not getting informed consent, which would be like, need to know the true side effects of this drug and how if you experience them, it might be contraindicated for you. If you're losing a super fast amount away in a short period of time, you then meet criteria for malnutrition diagnosis. Like, we're not, but like, here are the things that could work for you. And here's how we head off some of the things that, you know, could cause you trouble. We're not seeing this is how it could be helpful and this is how it could be harmful. 

Are you sure you want to do this? And so that is the thing that I think if a lot of people are getting a true informed consent, they might not choose to move forward with it. ⁓ But I do want to say if you're a listener and you're on one and you didn't get an informed consent or you did or whatever. Remember like practitioners don't fault people for going on it because we live in a culture that doesn't respect or believe the evidence of body diversity and genetics plays such a big role in how we show up in bodies in this world ⁓ along with lived experience along with disease states and all of that ⁓ and we unfortunately think that even in the medical system that thinness equals health and it really doesn't. What we're seeing is you know we're seeing that what we want people to do is like engage in healthful behaviors that you can do at any size right and so we've really taken a swing in the last couple years of like let's just engage in healthful behaviors to like just take this shot or this pill and then you'll be smaller. And so it's called weight stigma and bias and it's very, very prevalent in healthcare. And I find it quite harmful. ⁓ Most of my people that I encounter in my clients in my office find it quite harmful. But you can engage in health promoting behaviors without chasing a number on a scale. And I wish more people would let their patients know that.

Katie: Mm-hmm. Yeah, I do.

Leslie: Yeah, we're living a really tough time. This is a tough timeline right now.

Katie: Yeah, you know, I do agree and it's hard because you're right, even showing up to the doctor, right? Like, you know, my sister showed up to her doctor and, know, was told that she's, you know, borderline, you know, on the bigger side and she's not, right? She just happens to be more muscular. She just happens, which happens to carry a little bit more weight, muscle does. And so then she's left that doctor thinking, am I fat? And when it's like, no, you're not. And that's not the right approach that I think a lot of medical professionals are taking ⁓ along with when they prescribe these drugs without any sort of thought around disordered eating or the mental health or how that's going to impact them.

Leslie: Absolutely. And like we've got people that, you know, and make judgments based on someone's size and they have no idea about their whole history. That is called weight stigma. And weight bias is I'm making a judgment about you because of the body that you live in, the size of the body that you live in. That's weight bias. It's what I'm thinking about you. It's a prejudice. Weight stigma is when that bias turns into harm. And that sounds like maybe your sister experienced that. And so I'd say 90 % of my clients experience that in one form or another. ⁓ It's very prevalent in our medical community. And I'm not just harping on doctors and prescribers, dieticians, nurses, like we all learned it and we have to unlearn it. ⁓ But it's like, so like I'm a dietician and I'm, you know, I might show, I show up in a body that's not the smallest body and that's okay. But what we have to, and they're all bodies.

Katie: Wow.

Leslie: you know, have varying levels of fat. So if somebody uses, you know, fat in a negative way, we really have to get back to being like, lots of bodies have fat, all bodies have fat, fat is normal, fat is healthy. Some bodies have more than others, and that's usually a genetic thing. You know, genetics really drive the bus. You know, we have lifestyle interventions and lifestyle behaviors that do play a role, but they might not play as big a role as genetics.

Katie: Sure.

Leslie: And so we're far less control of our body size than we think we are. And when we try to manipulate it, we usually fall into some pretty harmful behaviors. But yeah, you're right. But I will say something that's helped a lot of my listeners in terms of their mental health when they go to doctor ⁓ is knowing that you have the right to decline a weight check. You can go in.

Katie: Yeah. Wow.

Leslie: And usually it's the, let's get your weight. And like, let's not. You have the right to say, no thank you, I'm not doing a weight check today. And if it sends you into a spiral or shoots your blood pressure up, you can say, I have found that that's really unhelpful for my mental health. If my provider needs a weight check for a specific medication or something related to my diagnosis, I'm happy to discuss it with them that you are not obligated to do a weight check in any office and if someone tells you you absolutely have to, one, check with the true provider because usually the person taking you from the waiting room to the room is not your provider. ⁓ Check with the provider and if the provider wants to make you do it, one, that's not, it doesn't align with do no harm. What they could say is listen, I really need it not for this prescription I'm gonna write you, how about we do a blind wait and we don't talk about it. And that way I have the information I need to really help you. And if a provider wants to provide, you know, offer harm reducing care, that's what it looks like. In most cases, you don't need a weight check at all. And I'd say 90 % of adult, like primary care visits, you don't need a weight check at all.

Katie: Interesting. I didn't know that. That's cool. That's Wow. Okay. That's good to know.

Leslie: Yeah, I haven't done a weight check in like three years. And I always test it for my clients. like, let me tell you how this one went. Sometimes it doesn't go that great and then my blood pressure is really high. And I'm like, see the weight did the weight check did this. something else that's important for your listeners to know is weight is not a vital sign. It is not a vital sign. They're like, what if somebody says it is a vital sign? I'm like, no, weight change is. Weight change is a vital sign.

Katie: Right? Yeah.

Leslie: And so say you came in and you gained weight, you might get a finger wagging of like, eat less, move more, you know, which is really, really lazy medicine. But if your weight has increased, what we want to hear is, hey, what's going on? How you doing? Do you have enough to eat? You know, a lot of providers don't even ask about food security. Like, how are you doing? You know, are you feeling, ⁓ how's your mental health? You know, the same thing if weight drops, like, you know, somebody is going to get a pat on the back if their weight drops when that could be because of an eating disorder or mental health concern or lack of food. So we really are having, you know, such a, you know, hard time, like with using way as an indicator of health and like really that weight change needs to be looked at. But in our current scenario, it doesn't, it doesn't work very well.

Katie: Yeah. Right. That's interesting. Oh my gosh. Well, that's a good symptom, a good tip to know for our listeners out there who maybe they're wondering whether or not they're on Ozempic or not or a similar medication. Do I have the symptoms of an eating disorder or is my body displaying symptoms of disordered eating? What would that look like? What should somebody maybe pay attention to when maybe it's time for them to step back and get some help.Leslie: Well, if they've noticed that there's a market decrease in their eating patterns. And typically people eat three meals a day, one to three snacks, depending on, even more depending on activity. ⁓ If people are, you're routinely skipping meals, if a meal looks like a snack and we're calling it a meal.

If you're having trouble going, you know, if you're having trouble with your GI health, like if you're having bloating or diarrhea or constipation, if you have low to no appetite, ⁓ that is a desire to not eat is a huge red flag. And that could be some disease state, that could be medication use, that could be disordered eating. ⁓ You know, if you are having trouble with your mood, if... I will say if your hair's falling out related to your nutrition, that that is kind of a late sign. know, hair sticks around for a long time until it doesn't. So if your hair, if you're having trouble with your hair thinning is a big one. You know, we'll go take every vitamin under the sun before we'll eat enough. So, I mean, because we've been coached like that in our culture, but I'm like...

Katie: Yes, we will. We have. Yeah.

Leslie: I know we have, taken all the vitamins. Really breakfast would be the answer here. So really skipping meals, fatigue, GI concerns, poor appetite, being afraid to reintroduce food is a really big red flag too. And dizziness, sitting to standing. ⁓

Katie: Yeah

Leslie: You know, there are a lot of things. Cold, if you're cold all the time, and like we live in Las Vegas, if you're cold all the time, we need to get that checked out. So, yeah. So those are just some of the signs and symptoms.

Katie: Yeah, right. Yeah, absolutely. That's good to know. ⁓ This was such an informative episode. I know we're at the end. Before we wrap up, I just want to talk a little bit about the state of Nevada. ⁓ from my research, it seems like there's very little support for eating disorders in the state of Nevada, which I think is unfortunate because I think in some ways, especially in southern Nevada, we are similar to that LA culture where we want to be stripped down in our bikinis, looking good. So it's like top of mind, right? We want to look good in our little outfits when we go to the clubs and it feels like there's not a lot of support here. And so just, is that true? Is that accurate? What do you hope for the future of Nevada when it comes to support for this type of mental health condition?

Leslie: I would say you're correct and it's really unfortunate. There are some really, really lovely therapy practices out there. ⁓ There are some great therapists in town that deal with disordered eating. There are some dieticians. We don't have a lot of necessarily medical providers. What happens is usually if you'll have, say, there's the Eating Disorder Institute, ⁓ there's several other

Katie: Yeah.

Leslie: practices that specialize in disordered eating. ⁓ I don't know if there are lot of insurance-based practices that have this type of specialty. We would hope one day we'll get there. But ⁓ there are practitioners that do specialize. And what happens, like if I have a client who's going to a doctor's office, I'm going to do a call before they go to say, here's what we're looking at. Please don't do this. Please don't say this. Here's what we really need here. Can you help us out? So I'm gonna do like a preemptive, please don't harm my person. Just not. It's not.

Katie: Wow. That's not normal. So that's not normal. You're going above and beyond for your patients, for your clients.

Leslie: Well, listen, if I can prevent some harm, because what happens if you have a harmful experience in a medical office is you don't go back. You don't go back when you actually really need something. And so if I can help, one, help a provider be a little more eating disorder informed, or if I can help my client not, you know, walk into harm's way, I'm gonna do it. That's why I don't take a ton of new clients, because I spend a lot of time helping my clients out.

But there are therapists that will do that too. We'll do a call ahead. So in terms of the medical piece, there are some good providers I've heard about, but it's like we haven't met everyone. So it would be lovely if we had some other medical providers that were really kind of a weight neutral approach where they're not harping so much on body size. And they're really looking at the broader picture of health, which is really behavior, mental health, all of that.

One day, I'd love to see some type of clinic that really was a weight neutral, health promoting, a mental health informed practice. It'd be lovely to see. I'm gonna be happy to come help be clinical director there if have some doctor who wants to do it. But I'd really love to see that. We have...

That's what I would like to see for the future. And then I think Reno might have, they do have some other resources and that's the other thing. I mean, if you need to use your insurance and things like that, there's some practices in Reno that do virtual. ⁓ So there's, that's an option too. So having virtual practitioners has really helped. And I have some clients that actually do virtual ⁓ medical appointments to work with eating disorder informed practitioners.

Katie: Mm-hmm. Yeah, and I'm sure that'd be helpful for our rural, too, for our folks out in the rural. you know, it seems like they don't get a lot of support ⁓ or just education, right? They don't know what's best. And so to have that support available is so valuable.

Leslie: Yeah. Right. Yeah, yeah. You know, I used to, like, I had a practice in Memphis, Tennessee, and then there was another town about an hour or so away, Jackson, Tennessee, and ⁓ they did not have a lot of resources, but they had a really amazing doc who was very ed-informed. And so, ⁓ you know, a couple times a month, I would go over there and do, like, the kind of, we would run a disordered eating disorder clinic a couple times a month. And ⁓ I'd love to see us go back to… having those types of care models where you have specialty clinics here and there where people who really, really need support can get it.

Katie: Yeah, absolutely. Here in Nevada, I think that'd be so valuable and it would be nice to see the future of Nevada that you're wanting and I think that we're fighting for it, right? ⁓ But it is scary times in many ways and it does feel like we're fighting an uphill battle with diet culture and ⁓ just so much around the medical field that still needs to kind of be maybe unlearned and relearned in a different, healthier way. So I know we have a long

Leslie: Right.

Katie: way to go, but I'm grateful for your presence here in the state because, you know, as we just established, you're one of the few experts. For anyone out there who maybe is interested in connecting with you or learning more about your services, ⁓ how would they go about getting connected?

Leslie: Yeah, well, you can go to my website, is LeslieSchilling.com, and that's S-C-H, LeslieSchilling.com. ⁓ I'm pretty active on Instagram, which is at LeslieSchilling, ⁓ and my latest book is called Feed Yourself, and it is available anywhere books are sold and on any audio.

Katie: Fabulous, that's so cool. It's available on Amazon too.

Leslie: Mm-hmm.

Katie: So cool, well I'm excited. Thank you for telling us that. I'm gonna go look up your book, I'm a big reader. And then just thank you for your time today and for everyone who is listening. Thank you for tuning in to this episode of watching mental health. I hope this was informative and helpful for anyone out there who is struggling with disordered eating or who's thinking about diet and nutrition and how that impacts your mental health. And with that, we will see you again next time. Keep a look out on katierosewector.com for all new episodes which are published on Wednesdays. Have a good one. Bye everyone!