[00:00:00] Shireen: Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

In today's episode, Lindsay Bailey, a seasoned registered dietitian, discusses the correlation between control and eating behaviors in children and adolescents. She advocates for the health at every size or HAES approach, challenges weight focused discussions about weight. and navigates integrating his philosophy into treatment plans for conditions like PCOS.

Lindsay emphasizes an addition focus mindset in dietary counseling for young people with diabetes and addresses the impact of anti diet approaches on mental health. Stay tuned. Lindsay Bailey is a registered dietitian, certified eating disorder specialist, consultant, and certified diabetes care and education specialist.

Lindsay practices from a weight inclusive lens and has a special interest in eating disorders, disordered eating. And diabetes. Welcome, Lindsay. Thank you. Thank you so much for having me. An absolute pleasure having you on. So Lindsay, we're really looking forward to this episode. We're really going to talk about eating disorders.

I feel like there's a lot around it that we can unpack on this one episode here, and it's still, there will be a lot more to talk about. But first, I just want to understand a little bit more about your journey. What sort of interested you in this space, specifically as you work with diabetes? Children and adolescents.

[00:02:05] Lindsay Bailey: Yeah. The funny thing is eating disorders has always been something that I've been super interested in since before I even started in nutrition. Looking back, I don't even really know where that came from, but now kind of after being in the field for quite some time, I think I really appreciated the fact that eating disorders had this psychological component to them, and that people that have You know, anxiety disorders, for instance, use eating disorders as a form of control to control things that they don't have control over in their lives.

So I really, was interested in this intersect between controlling food and how this controls essentially. So I don't think I really realized that at the time of my interest in it. But looking back now, I kind of see that as a dietetics major going to school to be a dietitian, eating disorders is not a very large part of the curriculum at all.

There was a very small section within maybe the medical nutrition therapy components of nutrition. But outside of that, Not a lot. By the time I got to my internship to practice to be a dietitian, I kind of consider a dietetic internship very similar to how a medical doctor does residency. No experience in the eating disorder realm either.

Even as an individual trying to seek that experience, I was oftentimes told, no, that it was, uh, An area of kind of protection, if you will. Like they didn't necessarily want observers and learners in that area. So understandably so it's a high level kind of skill. So everything I really learned from the beginning was basically self taught.

I would say I decided to do my master's thesis in the field of eating disorder. Since. That was my one way that I felt like I could start to get some experience in it. And I did my master's thesis on disordered eating in college aged health females. So that was really my first opportunity to be able to do some individualized research on the area.

And then within my first job, Didn't really have an opportunity to become an eating disorder dietitian right out the bat, of course, but I always kept my heart open to that. So about two years into my career as a dietitian, a very extremely part time position opened up at the children's hospital I was working at.

I was working in diabetes actually for some time, my other passion, but when I had the opportunity to jump into the field of eating disorders, it was only about, So, it was very self taught, but that's where I got my start. And now I'm a full time eating disorder clinician. 

[00:04:53] Shireen: You know, you mentioned a little bit ago around that piece of control, right?

And sort of what some of the things around control and how it's connected sort of to the eating disorder piece. How do you understand this sort of underlying logic of eating disorders? What is it within that? Help us understand that better. And how does one prevent it or what is even the appropriate approach to take here?

[00:05:18] Lindsay Bailey: Sure. Yeah. I would say the majority of people that I have worked with either formal eating disorders or disordered eating have a co occurring mental illness of some sort. So that would be something like anxiety, depression, OCD, ADHD. The majority of people have something else underlying mental illness related.

So what I tend to see is that if you are a person that has one of these mental concerns and you are genetically predisposed to having an eating disorder, Oftentimes something really just clicks that sets that into motion. So if we're already predisposed to having an eating disorder and we have other mental health concerns, it just kind of triggers the eating disorder into full gear.

So preventing is an interesting topic because it's also being able to understand who is susceptible to eating disorders to start and can we. truly prevent them. There are some preventative methods, and I think it is helpful to know that connection of who is predisposed. We might not always know, but we do know that kind of genetic component, familial history for sure.

But there are prevention efforts out there. So this really kind of looks at what are the negative risk factors to develop an eating disorder. So for many people, this looks like. a big tie to their body image and their self worth and how they are viewed in the world. This can also be body dissatisfaction, for instance.

And we live in a world of diet culture, so we're surrounded by this. So it really is important that we have these preventative efforts where we're changing the conversation on Health and weight and what is healthy, because things that we might consider healthy, a lot of people are in the pursuit of health may be predisposed to develop an eating disorder.

[00:07:22] Shireen: That is so interesting because that line, one is not clear, right? Like, it's not like, Clear cut. So I find that interesting. I wanted to get into another concept within this space that is in fact to what you alluded to earlier, this concept of health at every size, this approach, how does it influence sort of the work that you do in your practice, especially in the context, again, of adolescent medicine and even sports nutrition?

[00:07:49] Lindsay Bailey: So for our viewers and our listeners who are not familiar with Health at every size. It is abbreviated HAES. Some people may be familiar with that, but basically it is a framework that is used. And the definition of it is that people of all shapes and sizes deserve health care, regardless of their size, regardless of their weight.

And it's in an effort to also reduce weight stigma, which is very prominent in the healthcare space. So what we is oftentimes people who are in larger bodies. Oftentimes we think that correlation versus causation, their weight is the cause of the health concern. But we're seeing some really good research that's showing that weight stigma, yo yo dieting, these are things that are really having poor outcomes for people in larger size bodies.

And often there's a connection between people in larger bodies feeling that they're not adequately being cared for and they might not be going to the doctor to get annual checkups because they're afraid of that weight stigma or maybe the space isn't accommodating to them. So we're seeing some barriers to care and some poor health outcomes also related to weight stigma.

stigma, which is directly correlated with poor health outcome. So it is important for me to practice from that standpoint, especially as an individual who's working in eating disorder care. I don't want health to be based off of a weight or a number because we're really trying to change that conversation and have different conversations on how can we change our behaviors because weight isn't a behavior, particularly our children.

I think this is a really, um, particularly important concept because Working with children you may or may not be familiar with the idea of growth charts So if you take your child to a doctor Each time they go to the doctor, they're getting their heights and their weights. They plot that on a growth chart It's the cdc growth chart So, from age 2 to 20, we use a specific set of CDC growth charts from that age range and a person is plotted for their weight for age, their height for age, and then also their BMI, which is correlated from their height and their weight.

So, if somebody is at the 5th percentile weight for age or below, that is classified as underweight. If a person is at the 85th percentile and to the 95th that is considered overweight and anything above the 95th is considered medically obese. So it's very interesting because it's like, well, we have this like tight range of like what is considered a normal weight, but children don't grow all at the same place.

So it's really important for us to look at where is a child growing. Some children grow with the 5th percentile and they are medically healthy. Some children grow with the 85th percentile and they are medically healthy. So my biggest point that I want to make here is that the goal really should not be that every single person should be at the 50th percentile.

That is the average For a reason, we have averages when we talk about bell curve. So the goal should not be getting everybody at the 50th percentile, but really to follow specific growth curves and where our child should be growing for them. 

[00:11:01] Shireen: You know, what you mentioned here also leads me to, in fact, my next question, which is around this HAES philosophy that you explained to us.

It also, you know, sort of intersects to some of the other sort of conditions that may exist. So what challenges do you face when integrating this HAES philosophy into treatment plans for let's say PCOS or even Turner syndrome for that matter, which might traditionally involve a very weight focused discussion.

[00:11:31] Lindsay Bailey: That's a really great, great question. And I had a lot of experience that in my earlier days as a diabetes and endocrinology dietitian, where I would get referrals to meet with patients. for those two conditions, PCOS and Turner syndrome. And oftentimes, the medical personnel and the healthcare providers had an idea of what my education should look like for them.

Oftentimes, I think the misconception with PCOS, for instance, is that weight gain causes the PCOS, where it's actually the reverse. The PCOS causes the weight gain because there's an issue with our hormonal balance that is going on. It's causing all of these different things. So, the standard messaging that would happen in these populations is, you know, be put on a weight loss diet, count your carbs or limit your carbs, cut out your carbs.

So, these are very standard messages. standard messages that are being held in these spaces. So absolutely trying to come at it from a completely different approach, like a HAES approach where we're not even focused on the weight. It's extremely challenging because as a dietician who focuses from a HAES approach, how do I get the healthcare providers to be on my side?

And how do I get the patient to understand my side as well? So it's really important that we build trust with both sides, the healthcare practitioners and our patients. So I do feel like it's important for us to have the research on our side. continue to talk about Health at Every Size and why we promote this.

And what I think is really wonderful now is that there is some great information from the Health at Every Size HAES worksheets I really like as a dietitian, because these are medical nutrition therapy worksheets that we can use with patients that aren't weight focused, but are still MNT or medical nutrition therapy, which is what we use as dietitians.

So we can still work with our patients. in this HAES lined practice. And really what I have found is that for a lot of patients, this is a sense of relief when they're meeting with a provider who isn't blaming everything on their weight and they're meeting them where they're at. And we are talking about things that they can change, not things that they necessarily can't because we know the success rates of diets long term, 5 percent or less long term for most people.

So it's not a sustainable approach. Especially for something like PCOS that already is very difficult to have even short term weight loss. 

[00:14:04] Shireen: How do you approach dietary counseling for children and adolescents with either type 1 or type 2 diabetes? I know you mentioned your second passion is diabetes, so can you speak a little bit about that? And especially with those who are again in this intersection of also struggling with eating disorder. 

[00:14:21] Lindsay Bailey: So, I'm going to kind of preface this with, like, the same but different, so I'll elaborate on that. I think sometimes there's a misconception that type 1 and type 2 need to be treated different dietarily, and that's unfortunately something that I have heard oftentimes, is that type 2 is something that you do to yourself, which is really unfortunate and not true.

So, um, The biggest misconception with diabetes is that we have to cut out foods in order to control our blood sugar or take carbohydrates out of our diet, for instance. There's a lot of eat this, not that type of language that patients with type 1 and patients with type 2 diabetes experience. So first and foremost, when I'm working with a patient with type 1 or type 2 diabetes, I want to know where their knowledge is.

I want to know, do you even know what carbohydrates are? Do you know how they impact your body? Just educate first versus saying, eat this, don't eat this. So I also like to practice from what I consider an addition standpoint versus a subtraction standpoint. So subtraction. gives the connotation that it's something negative like eliminate this from their your diet or this is bad that comes into play specifically with people with Disordered eating as well viewing foods as good versus bad.

So the addition mindset would be okay Carbohydrates affect our blood sugar What can we eat with these carbohydrates to help stabilize our blood sugar? So are we educating on how do we add adequate protein when we're eating carbohydrates? What is fiber and how does that affect my blood sugar? And outside of food, exercise.

We know that exercise and movement can be really helpful for blood sugar control as well. So, The addition mindset is very helpful for people because they're seeing things on like what can I do to add to my life or add to my diet versus always feeling fearful of foods or As if I have to take things out and I really do want to bring up a point about insulin So people with type 1 diabetes or insulin dependence People with type two aren't necessarily dependent, but may become dependent.

So I think there's also a thought that if you're on insulin, we have to count our carbs and we have to take the appropriate amount of insulin for a food that was kind of the older way of managing diabetes, but there's a lot of fear with that like What did this food do to my blood sugar? And oh no, I was bad and it made my blood sugar go up.

But knowing that can I correct this at the next meal? And what can I maybe do differently or change to add to this to make a change? So it doesn't again need to mean that we're eliminating things, but just learning what we can do to help take things into our own control.

[00:17:02] Shireen: Which helps me actually go into the next aspect of what I would like to cover here. Really from your experience and seeing what you've seen, what impact does an anti diet approach then have on mental health of young individuals dealing with conditions like let's say celiac disease, where the diet is just very inherently restrictive, where you don't even have an option. 

[00:17:27] Lindsay Bailey: So, what I would say to people dealing with something like celiac disease and this anti diet movement, I could see where there might be this idea that like, Maybe there's a perception that I am following this diet, and how could that possibly be anti diet if I'm following this diet.

So I'd like to remind our listeners and our viewers that anti diet does not mean we're against diets, we're against diet culture. And anti diet also does not mean anti medical nutrition therapy. It could very much involve medical nutrition therapy. So I don't want this population or any population that needs to follow a specific diet to feel stigmatized as if this movement is not appropriate for them.

It's really just anti diet. diet culture, as I say, but we can also implement MNT. So I think about celiac disease, like I would think of an allergy, that food is going to be harmful to somebody's health if they ingest that. So that is something that we need to avoid for our health. So I take that approach where it's like this food would actually benefit you and would not be healthy for you because it's causing damage to your body.

But, okay, gluten contains specific vitamins and minerals that we need. How do we shift the focus on making sure we're getting those foods and nutrients in while also taking care of your body and avoiding those foods? So as a dietitian, Typically the approach that I'm taking, we're still implementing medical nutrition therapy and finding ways to achieve that nutrition balance while also taking care of the individual and making sure they're having foods that they cannot have in their diet.

[00:19:03] Shireen: How do you implement unique eating practices for young female athletes? Let's say, what are some unique challenges they face in diet and nutrition? 

[00:19:13] Lindsay Bailey: Sure. Yeah, this is a big one. I see a lot of athletes in eating disorders and this is for multiple reasons, but just kind of going back to like, what are the challenges?

I think a lot of athletes are really unaware of what, how much nutrition they truly need. So number one, there's a misconception about what their needs are. Maybe somebody is eating breakfast and lunch and dinner, but they have such a high level of output from their support that they're not eating enough to meet their needs.

So what is that code is they're having low energy availability because they're not eating enough for the demand from their support. So oftentimes, sometimes we can address that and talk to them about how they can make sure they're getting enough nutrient density in their diet. And that's fine and dandy.

They're able to make those changes. They succeed in their sport. But other times, this is where we really kind of find people that struggle with disordered eating and eating disorders is when they're not able to make those changes when we're like, okay, your energy intake is here. Your activity's here.

How do we get your energy up here? Oftentimes that's where we start to see things like disordered eating and eating disorders come into play. But there are a lot of challenges. So me working with children and teens, I have to look at their school day. Are they eating breakfast before school? You would be surprised how many aren't.

Are they eating their lunch in school? Maybe, maybe not. If they're not eating their lunch and then they're going straight to practice and they're not eating a snack beforehand. There might be a gap from possibly 10 30 in the morning if they have a really early lunch to not eating dinner until seven o'clock at night.

It's a long time for anybody to go without eating, let alone, we have an activity that we aren't feeling for, and we're not getting enough recovery. And so oftentimes it's trying to Figure out the barriers. How do we meet nutrition? How do we get creative and make sure you're getting enough in? I really think that the biggest focus for kids and teens that are athletes is We still need to consider that they're growing.

This isn't an adult athlete that doesn't require extra energy for Growth and development. So I have that added layer on it. Like you're still growing and developing meat, even more calories and nutrition. So it is possible that your child or teen needs more than you do mom and dad and grandparents. I hear that a lot.

They're eating more than me. They probably need more than you. There's a lot of demand. 

[00:21:40] Shireen: Lindsay, thank you so much for helping us understand a little bit more about this space and opening our eyes to how layered this challenge is and how much there is to unpack within that as sort of someone is working through some of these things.

At this point, I would just love for our listeners to know how they can connect with you, learn more about your work. 

[00:22:03] Lindsay Bailey: So, I am the lead dietitian with Kayla Jessop Nutrition. She is based in Utah. So she has in person visits as well as virtual. I do my clients virtually. So she can be found and I can be found through KaylajessopNutrition.

com and then also through our Instagram handle, uh, it's KaylaJessopNutrition as well.

[00:22:26] Shireen: Lovely. And we'll make sure to link everything in the show notes below for all of our listeners here today. With that, Lindsay, thank you so very much for making the time to connect with us. To our listeners, thank you again for tuning in to another episode of our Yumlish podcast.

Continue to listen in, chime in, let's continue the conversation on our social media. What did you think about this episode? Find this podcast post on Facebook at Yumlish or on Instagram. Find this podcast post and comment below again to tell us. What did you think about this episode? We'll continue the conversation there.

Let us know your thoughts and what you thought. And Lindsay, again, thank you so much. 

[00:23:03] Lindsay Bailey: Thank you. Have a good day. 

[00:23:07] Shireen: Thank you for listening to the Yumlish podcast. Make sure to follow us on social media at Yumlish underscore on Instagram and Twitter, And at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.

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