Despite the return to a semblance of normalcy post-pandemic, the prevalence of eating disorders among young people remains. The isolation, anxiety, and disruptions caused by COVID-19 have had lasting impacts on mental health, contributing to a sustained increase in eating disorders. Kyla Fox, a licensed social worker, clinical therapist, founder of the Kyla Fox Centre in Toronto and mother of two girls, shares her professional and lived experience on the topic in an interview with Lianne Castelino of Where Parents Talk.
Q&A:
There are all kinds of statistics about eating disorders on the increase as it relates to hospitalizations, and certainly among young people over the pandemic. Kyla, could you take us through some of the current trends that you are seeing around eating disorders and young people?
Well, the truth is, is that even though the numbers were skyrocketing during the pandemic, they haven’t slowed down. And that’s the very sad truth about eating disorders. And despite the fact that life has found itself back to normal in many ways, what we what we do see is obviously, the impact on mental health for young people has been tremendous. Young people are still deeply impacted by COVID and all of the repercussions of what that meant for their lives. And so, eating disorders still find a very, very real place for so many young people and in so many families.
As an eating disorder specialist, what concerns you most about what you’re seeing?
I’ve always been deeply concerned about people impacted by eating disorders. I think my concern isn’t any more now than it ever was. The reality is that there’s more that we obviously are speaking about when it comes to this issue. Part of what we have to recognize about eating disorders is that they show up in food in the body when it comes to their presentation, but they’re really actually about so many other complex issues that show up in young people’s lives. And so though, we may try to look at a person’s relationship with food and their body and dictate their capacity for wellness, or the trajectory of their recovery, what we have to be very, very mindful of are the psychological and emotional or relational, familial biological impacts that have happened to the people who are impacted and really work at addressing those spaces.
The other thing that I think is important, too, is that when we’re working with young people, at least at the Centre, for sure, we’re always working with families, and we’re working very, very closely with parents, because we know that parents are the are leading the way for their children’s lives. And so part of a huge piece of our care is helping to teach parents and support parents, and how to really, really create open communication and connection and learn about eating disorders in really new and different ways so that they can support their children quite differently.
Could you provide some examples of some of those extraneous issues you refer to that would affect an adolescent a young person that could potentially cause them to have an eating disorder?
It’s really anything that could happen in someone’s life. I think we can never underestimate the constitution of a person in terms of their ability to move through things or how they do. I also think that, the impact of COVID familial situations, peer experiences, social media, pressures of life and school, the way that kids feel about themselves, our sense of worth is really very much at the core, in addition to genetics and those kinds of pieces. Sometimes people will say to me, Kyla, what is the thing that sent my child in this direction? And the truth is there often isn’t a thing, there often isn’t one golden nugget that pivoted someone down the road of an eating disorder. What I really talk about is, is the ways that all of our life experiences shape us, and depending upon who we are, we are, you know, we manage those experiences in different ways we move through them or not in different ways. And so all of those things make up what might lead a person to want to control food and their body.
How often is a parent’s relationship with food, something that they inadvertently or maybe intentionally project on their child, and therefore that then becomes a main cause of that child’s relationship with food?
It’s such a great question. I answer this not to blame parents, because I think that we all are moving through so many things in our own lives. But I do think it is a very important factor, because as parents, we shape the environment for our children. And we also model and give information about food and bodies, even if it’s about our own body. And the incredible thing about our children is that they love us, and they’re sponges to our experience. And so what we do, what we say, how we understand the world, the judgments we make on ourselves, or others, our ideas about food — healthy, unhealthy, good, bad, — all the things that we speak about that we might also not even be conscious of that are informing our children all the time about who they are, how they should feel about themselves, how we feel about ourselves. So I do think it is an a very important piece, especially in the work of recovery that parents participate in that work, too.
What do parents need to know about whether a child is truly a picky eater and has a dislike for certain foods versus something else?
So one of the eating disorders that has a lot of prevalence is called ARFID. It’s avoidant restrictive food intake disorder. And it definitely shows itself in the form of picky eating. There are a lot of children who present as picky eaters, and it may be quite innocent. Sometimes it’s really just an assertion of some element of control. Sometimes it’s legitimate like and dislike. And it’s hard to always know the difference except to say that if picky eating becomes a way that a child is there, for them more isolated and unable to integrate into certain situations, is incredibly narrow in their food choices, and therefore is nutritionally deficient, or isn’t growing up to capacity on their growth chart, when it’s starting to affect kids, obviously, mentally, emotionally, psychologically, physically — those things are obviously very much more in the direction of an eating disorder. And so ARFID is an eating disorder that presents itself in younger kids, usually 12 years and younger. And so it’s about monitoring when a young child is a picky eater and then can maybe transition and move through environments and spaces with food with more ease. Or if they remain quite steadfast in their decision making and don’t have a lot of openness or room for breaking out of their particularities and such.
In that case, then when should a parent consider getting help? And where should they go as a next step?
I say this as a parent, too. There’s two pieces that happen even for me as a parent, it’s like, do I make this a big deal, is it a big deal or should I leave it, aybe they’ll grow out of it? And so I feel like we’re always navigating that as parents, like, when is something important enough to address? And when is it not? When do you just leave it? And you know, I think about that with my own daughters as well. I think that that, you know, if it’s if it’s concerning for you, if you’re feeling like it’s occupying your mind time and energy, if it’s changing the way that you’re, you know, connecting to your child or how you’re addressing things with them. I would say for sure, you should ask for some support. And at least I feel that information is invalid and it allows parents to at least have made connections to feel like they’re heard and listened to, and ultimately to have some direction.
Is there an ideal window of time then if you are concerned, but not sure and contemplating getting external help, that you should be taking action with a potential eating disorder?
A lot of times, people will say is I didn’t know, or we didn’t think it was as serious as it was, or my child was engaging in what we deemed as healthy behaviour, and so it didn’t seem problematic. So I don’t want to suggest that there’s like a short window, and if you miss it, that’s it, you’re done. I don’t think that’s the case. I think what is important is that you do enter into that window, or you do ask for support wherever that may be, so that your child knows that you’re aware, you’re thinking about this in a different way, you’re taking this seriously, and at least you’re asking for other insights and answers that I think are really, really important.
What about the parent who maybe has made the decision to get extra support from a professional for their child, but now is faced with a child, adolescent, teen, tween who does not want to participate in getting help? What can you suggest to that parent?
We see this all the time. Parents are worried and ready and will do anything and their child is resistant. So I suppose age and stage of life determines whether or not a child would have to participate in care. But what I always say is that there is so much work that we do with parents, specifically when their children are not open, willing, ready to engage, because when some part of the system starts to make change, it actually does shift the system entirely. And so if parents are engaging in treatment, and in recovery, and are getting the support that they need, that will start to change the way that they interact with that child, the things they say, the way they go about things. And that will inadvertently start to shift the patterns in the home, and hopefully get that child to a place where they would be more open to joining into the process. I think what we can do as parents is model what we hope for, and if our child sees that we’re engaging and care, and it’s okay, and it’s safe, and it’s normal, then they may be more likely to sign up to. So I think it’s just really important to do that. I also feel like the other pieces, of course, are if your child is medically unstable, or if there’s things in that realm, then then serious action in terms of making sure they’re safe need to be taken. Professionals can guide you in those pieces too.
With respect to your clientele, the families you see the young people you deal with, are there certain sort of patterns in terms of obstacles and pitfalls, that you see families falling into — that then could become a real potential catastrophe by the time they come to see you?
Well, I think and I say this also, as a parent — we love our children so much, there’s nothing we want to do except to see them thrive and be well and happy. And I think inadvertently, what may happen a lot, especially with children and parents is a probably a bit too much time negotiating, and a bit too much time allowing the child to have so much insight and input into who their care needs to go. Sometimes, I when someone’s really impacted by an eating disorder, they don’t necessarily feel ready to get help.
They don’t necessarily know that they need it. They don’t necessarily think there was a problem. And so I think a lot of families spend a lot of time trying to convince or negotiate. And I would argue that perhaps those kinds of patterns are things that we work on a lot — just to help end those cycles, and just teach parents how to have different boundaries and different language so that those patterns can can start to go away.
It certainly would appear that we’ve come a long way as a society in terms of the discourse around eating disorders. What is your assessment of where we are in society today on this topic, and where do we need to go?
I think eating disorders are more spoken about, but I do feel like there’s space in the language and understanding of eating disorders that require a lot more knowledge and information and I think that, when we think about eating disorders, it’s often that people will think about things like anorexia or bulimia. The way that we talk about eating disorders at the Centre is really more about the behaviours in terms of binging, purging, and restricting. And that’s because most people who are impacted by eating disorders don’t fit nicely into those boxes of anorexia, bulimia, or binge eating, or orthorexia, whatever that may be.
Often people across the journey of their suffering vacillate through different ways of being with food, all of which encompass at one point or another, perhaps binge purge and restrict. So part of what I think opens up for people, if we can consider those labels differently, and just really look at the behaviours is that not every single person who suffers with severe restrictive tendencies is anorexic or may even appear as such, but it doesn’t mean that they’re not severely restricting. Similarly, not every single person who’s engaging in cycles of binging and purging will consume as much as what we would typically understand as a binge, or purge through vomiting.
We have to sort of open up the spectrum of how we think about eating disorder behaviour, and also not look at people’s bodies as a measure of their wellness or lack thereof, but really start to see eating disorders beyond what a person looks like, beyond what they do or don’t do with food, and really recognize that this is a most severe mental health issue that impacts people and moment by moment, for a very, very long period of time.
As a teenager, you suffered with anorexia. Looking back, were you able to pinpoint the root cause of why you went down that road, and also take us through what you wish you would have had access to in terms of help and support and treatment that you now provide at your Centre?
I feel like one of the things there isn’t, there isn’t one particular root cause. But what I have come to really learn is that so much of what I’ve been through in my life shaped me, and taught me about who I am, who I’m not, my sense of worth. And I think that there was a lot in my life that was often not talked about, there was a lot in my life that I felt I had to live up to, there was a lot of performance. And I think a lot of pretending and I think often in response to so much that I didn’t understand when I was young. And so much that was just really unsaid, and not really dealt with. And so those elements of restriction, if you will, like the silence, and the secrecy and the withholding, and the pretending that really started to transform itself into my need to restrict something I could control, which was the food.
One of the things we talk about at the Centre is really helping people to understand the eating disorder symptoms far beyond food in the body, and to see how they show up in people’s lives, which is really at the core of what they have to address. So when I think about some of the ways that I would have really required a lot of support, I think first of all, I needed treatment right away, I needed people who understood eating disorders very, very well, and I needed that to be x.
I needed to have access to that care immediately. That wasn’t available for me. So I think that is something obviously that I’ve tried to close the gap on in terms of having the Center — is really knowing that people don’t have to wait for care, we can provide services for people right away. I also think that it would have been very, very important for my parents to join me in the process, and for the long term, because I think our family needed to do a lot of work to process the things we had been through that really impacted not only my life, but the lives of my siblings and my parents.
What I really do find at the Centre is that, people can move through recovery in really different strides when those around them are really actively involved in the work of change. And not only the person who’s the identified person with the eating disorder, that they’re not the only ones doing the work, but that everyone around them is too, which actually really helps them to feel like they can as well.
It must be pretty transformative when you see that playing out with your patients and their families. How has your lived experience with an eating disorder impacted the way that you parent, your young daughters?
Oh, my gosh, Lianne, I’m like, I could go on forever, because I think, as a starting point, I come into being a parent at a place of feeling so deeply privileged that my body allowed me to do that, which I never imagined it could, after all I had put it through. I also think that it matters very, very much to me, that in our family we talk always about feelings and experiences, and we are not a perfect family. I am certainly not a perfect parent. Nobody ever could be.
The way in which repair happens is a very critical part of how I tried to parent, which means that should things happen, or when feelings get hurt, or when conflict occurs, or when something happens in someone’s life that it isn’t about pretending it didn’t happen or brushing it under the rug — that there is a level of responsibility that I step into as a parent, when I do something, or I just feel a tremendous amount of responsibility to model what it means to be imperfect, and to model how to create correction, and to model that there isn’t such a thing as perfection, we do a lot of talking in that way.
I think when it comes to food in the body specifically, over the many years, I’ve worked in so many different ways to have a space of peace when it comes to food in my body. And I do really feel like I’ve reached a place of that. I feel like I can model that differently for my children. We talk a lot about the body, and we talk a lot about food, we come together around food very consistently, as a family. I really try to normalize eating. I eat the things my kids eat, they eat the things I eat. Food is like a really safe and beautiful experience for our family. And I think it’s really just, talking — we do so much talking. I know that sounds maybe a bit crazy.
We do so much talking because sometimes I think as parents, we think our kids don’t know, or they’re too young, or they’re resilient, they’ll get over it. But I actually feel like kids are so wise, and they absorb so much. If we can give more space to let them express themselves, it’s very powerful to hear what they understand, and to be with them through their feelings and through their life experiences.
Kyla, you are the parent of two young daughters. Girls typically tend to be more affected by eating disorders, not exclusively, but more so than boys. Is there anything else that you do when you’re talking to parents of girls who may show signs of an eating disorder?
Oh, as a parent, I feel equally worried and frightened about those things. Just because I have this expertise and do this work every day, it doesn’t mean I’m exempt from the fears or the worries around what it means that my daughter’s will be exposed to all the things that every young person is as well. I think part of it is just creating openness, so that they come to me. I want my children to come to me, I want them to know that is safe for them, I want them to know that there is an open road, that I will be able to receive what they’re moving through. And not that I’m going to always just be so light about it, but I’m going to help them, and I’m going to guide them. And I feel like that’s what we try to do as parents in our home, is just really create this deep understanding that we are there. And not just that we say it, we’re modelling that all the time.
Our kids go through stuff all the time, age appropriate things all the time that impact them, that change them, that hurt them that, make them do all kinds of things to them. And I think part of what I’m trying to do all the time is set the foundation for when the really differently hard things happen, that they can come to us. And so it’s like keeping an open mind. And I do a lot of like, you know, sometimes I just might take a few breaths before I say something so that I can just be really grounded, I give a lot of space for them to share. I don’t you know, I don’t do a lot of like, oh, you’re okay, or don’t worry about that, like I actually do more of like, tell me more about it teach me like what does that feel like for you? I do a lot more of those kinds of things. Because I really want to invite them to know that whatever it is that they’re going through that they can they can share that with me.
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