The next chapter with the premise ripa Pad is a production of I Heart Radio. Hey Everybody, it's Prim. Welcome to the next chapter, presented by Baron Davis and Slick Studios. So this week's topic, we're going to focus on a topic rather than a okay, three three to the next chapter with primis ripa Pad is a production of I Heart Radio. Hey everybody, it's Prim. Welcome to the next chapter, presented by Baron Davis and Slick Studios. This week we're going to focus on a topic, and the topic is about eating disorders and disordered eating behaviors among athletes. I'm actually currently co authoring a chapter in a soon to be published book on this topic, and one of the main contributors is a former Olympic figure skater, Rachel Flat, who was also a PhD Clinical psychology student at u n C. Now, some of you probably recall she's been a guest here on the next chapter, and in that conversation we talked about her retirement experiences as an elite app So if you haven't listened to it, definitely check it out. But this time around, I wanted to delve into her developing area of expertise which is eating disorders within the athlete population. As some of you know, this is a topic that's very important to me because I was one of those athletes that suffered from an eating disorder, and one that began shortly after I suffered a significant injury at seventeen years old, and it's one that I battled all the way into my early thirties. Actually, and as you'll hear from Rachel, this is one of the most difficult mental health issues to manage and navigate because of how long it takes the individual to get help and begin and also complete that recovery process. And so today what I wanted to do is really dive into this topic about athletes and eating disorders and not only dispel myths, but educate listeners on the warning signs of an athlete who might be struggling with this and also the typical course of this illness and what coaches, parents, and other athletics staff could do to help rather than harm, an athlete who is suffering from an eating disorder or disordered eating behaviors. And just so all of you know, by definition, eating disorders are mental illnesses because there are different types of eating disorders. So that's plural mental illnesses that are typically characterized by unhealthy eating patterns and weight control behaviors that negatively affect one's physical health and or psychles social functioning disordered eating behaviors, on the other hand, are a host or collection of at normal eating patterns that are actually quite common, but they do impair one's physical health, but they do not meet the clinical diagnosis of an eating disorder. So I just wanted to give you the definitions of both terms. And I thought it would be really helpful to talk to Rachel, not only because this is what she is researching and centering her clinical training around, but because she has experience of an app so she can speak from that perspective. And as a member of the United States Olympic and Paralympic Committees Mental Health Task Force, this is clearly something she's really passionate about and she knows a lot about. So without further ado, here's Rachel flat and so here we are. You've recovered, You're making this transition, and I find out so cool that you know, you and I have are kind of following a similar trajectory. You know, you're you go from elite sports and then now into the field of psychology, although you didn't you skip the whole part of spending eighteen years and media and broadcasting. You're You're much more efficient than I. It's a much more direct route of getting towards that. So, so how did you get there? I know that's a complex question because you're originally pre met but but why psychology and why clinicals like? Yeah, So I had started doing a little bit of research my senior year college UM with my former p I at IT Stanford, and he did a lot of work on UM digital mental health tools with a specific focus on eating disorders. But the project that I initially started on was, uh, this kind of staying fit, you know, keeping at risk kids in San Francisco physically engaged in activities, you know, helping them build some better nutrition habits, UM like sleep hygiene, just kind of hear some basic skills on how to kind of keep yourself healthy, UM to kind of prevent these higher b M I s later in life. And UM and he thought I would be a great fit. Knowing my athletic background. It sounds great, you know, this sounds really fun and UM and I was a biology major, so a lot of pieces to that project really spoke to me and and so I started working on that project and UM after retiring. After graduating, I took kind of a I don't know, a six months, eight months kind of gap before one of his one of the people in his lab reached out and said, hey, we have an opening. I know you're still on the bay and trying to figure out what's next, because I grabbed coffee with her and I was like, hey, guess what out of line to med schools, So I don't know what, and and she happened to find out that there was a position opening, and so I kind of re entered his his work and his lab through more of this digital eating disorder intervention lens and started working on a National Institute of Mental Health funded research project where we were delivering uh, kind of the very first stepped care intervention and prevention model that was gosh, we I don't know, it's almost thirty schools nationwide there were we screened thousands and thousands of women, and we were able to kind of see pretty amazing effects almost similar to what we would typically see with in person eating disorder treatment, UM, just through this digital app. And I was like, my mind was blown. I was so excited that I just saw so many applications um to the tremendous gap and resources in the sports world and um, so yeah, So I got really excited about that, recognized that we could really use something like that in sports, and especially in skating because eating disorders and disorder eating and poor body image or just so so common and um and so that got me really excited and that kind of lit my fire again. And so yeah, I ended up deciding to apply to graduate school and pursue clinical psychology so I could balance kind of this research and the clinical practice and even the advocacy work um that comes with with this, you know, kind of this education and um yeah, and it just was so interesting to me. I loved the idea of having a multiple, multiple different career paths that I could pursue, and um yeah. So I jumped right in, got connected with my current PhD advisors, Innibiolic, and turns out she has a background in skating. She's been a life while skater herself, and so there were just so many overlaps for us that I was like, yeah, I can't not pursue this. And here we are five years later, I'm playing for internship and almost done with this process, and it's kind of hard to believe that this has all come together. And I'm really grateful that I went through those experiences now because it's really informed and motivated this work for me um. But I yeah, I really couldn't have gotten to this place without having gone through that. It's amazing and congratulations and all the success and work, and I feel like it's like one of those weird things where it's like for for us going through the doctoral program, I guess it's like one of those things you don't really get the congrats until your license or something. It's such a long process, like we deserve because you deserve a congrats, like in the middle, like you're almost done and you've and you've gone through all the hard stuff and the work now is hard. I know it's stressful, but really like that hard personal inner work was like beforehand, and you know now you're like offen running. So I really want to dive into this topic because this is one that really hits me on a personal level. And I've been some I've been public about this, and I've mentioned this in other interviews, but for me being a tennis player, and then, um, you know, I experienced a pretty significant injury. I had a couple of stress fractors at seventeen, right before I was being recruited, and it really prompted, uh, what began as kind of an eating disorder. And although I never was clinically, UM, I was never really diagnosed because I wasn't meaning with therapist at the time. But it's one that affected my life really on and off through my late teens and then into my twenties, and then of course definitely when I retired. Uh, it came at a full vengeance and it was the reason why I went to therapy. So this is a topic that I'm very, very passionate about. Um. So I'm trying to figure out where to begin. But you and I were in the process where in the process of writing and co authoring a chapter on athletes and eating disorders and disordered eating, which is so exciting. So, um, you know, the first question is our athletes more susceptible to eating disorders and disordered eating behaviors. Let's begin with that. What are your thoughts? Sure? Well, before I get to that, I want to first say thank you for being open about your experiences, because I think that in and of itself can normalize like getting help talking about mental health publicly and privately, you know, with people who love you most. So I just yeah, very appreciative that you are willing to share up with so many people. So, but to answer your question, UM, I think we athletes are at least as susceptible to develop a needing disorder, if not more so. And I think it's really context dependent. UM. There are certainly some sports like figure skating, like gymnastics, UM, like long distance running, where are there is this perception that being thinner or even if there's a weight class kind of like wrestling, UM, where there may be very real pressures to maintain or lose weight and UM. And so sometimes there's this perception that you know, being thinner maybe providing some kind of performance enhancement UM or advantage. And when that's not always necessarily the case, and in most cases it's not surprised, UM. But it is in those types of sports where we tend to see much higher levels of eating disorders and disordered eating and concerns about you know, your your body and your weight and your shape. So UM, there's some evidence out there that even competing at a high level in sports can increase that risk. It's a little bit missed, um, but I think more often than not, being at a high level of competition and sport can increase that at risk inpparently because you're you know, you might be interfacing with a lot of different people who are giving you a lot of different pieces of advice. And you know, I think back to my own skating career where the more I kind of rose through the rinks, the more pressure I got, and the more feedback, like direct feedback I got on how I looked my weight, how my costumes looked, how I should have used different types of costumes to hide my physique. Um, And yeah, I'm you know, even I think back to a lot of experiences that I've heard from friends and peers and athletes who are still kind of going through that pipeline, and it's just amazing to me that those kinds of comments are still put out there. Um, So those culture around that is starting to change now that people are being more open and frank and honest about their experiences. Um. But yeah, I think they're they're certainly some sport contacts that definitely lend themselves lend itself to a much greater risk of developing an eating disorder. Yeah, and and you know, I didn't mean to put you on the spot. It is a very complex, uh answer. Uh answer is a complex UM question. And obviously the research is still kind of evolving and developing, and depending on what study you're looking at, UM, you're gonna get different answers. But I think, you know, if I were just offering taking off my like clinical hat and my research had I do think that for various reasons, I do think that the athlete population is certainly very susceptible to at least under this umbrella of um, you know, eating disorders or disordered eating behaviors. For various reasons. I think the stressors, especially in today's sports landscape is so different. There's just more eyeballs or social media. There's a social media alone. It's just like, I mean, just the amount of pressure and body image. So, you know, I want to talk about the factors and like really stripping this this UM this topic down and educating people who are are comeing out you know, from from various UM aspects so we can better understand this topic. Because I think, you know, sharing a little bit more about my personal experience. Sometimes there's this idea or this perception. Then it's like, okay, and eating disorder really begins with they just want to lose weight. They just want to be skinny, it's all, you know. But there's multiple factors that can kind of play into that. So you know, when I say that, is there anything that comes to mind in terms of like the contributing factors that lead to this? Yeah, I mean I agree that there is this general sentiment out there that the reason eating disorders happen is because people decide to lose weight and then they develop kind of these these harmful behaviors um that lead to kind of this long sustained eating disorder journey. UM. And that's certainly not always the case, but I think the sports environment can certainly contribute to that in many different ways. Like I said, you know, there's with with being a public figure, and you know, even I think about this and I'll deal to with n C double A athletes. You know, I'm so worried about what that might mean for athletes who are not only trying to physically be, you know, at a place where their body can perform the way they wanted to UM, but are now also pressured to convey a certain type of physical appearance UM that would garner them more followers, more influenced UH in that space, and I really worry and wonder about what those long term effects might be. UM. Certainly, I think from a financial perspective, so it can be so helpful for a lot of athletes and can really alleviate some of the burdens of that kind of participation. But yeah, I mean there's a lot of different roads we could go down, from social media factors to both infernal and external pressures to UM kind of keep a certain type of physique that is perceived to be the ideal physique for a sport. And certainly there may be certain types of bodies or certain types of physiques that you more often see, you know, me being a five to person, not a great basketball player. You know that just never that is never going to be the case. I'm right there with you at five. Yeah, but but I think you know, you look at like gymnastics and this whole revolution that they've had from UM athletes who tended to fit this certain type of mold of being really UM kind of spelt and toned Um, and now you see you know, you see powerhouses like Ali Raceman and Simmone Biles and Laurie Hernandez who have come through and completely changed the game to show that actually you can even be more successful when you're pushing against kind of the typical stereotypes. Um. So it's it's I think there's a lot of different things in the sports environment that can contribute to eating disorders or at least kind of increase the risk for it. But I don't think it necessarily comes down to just this idea around losing weight. Um. There's a lot more complexity to that. Yeah, and you just mentioned the societal pressures that impact that's kind of always evolving, you know, compared to I mean, I think, you know, around the eighties and nineties, I was a period when uh, females and sports was really kind of on the rise. So I benefited from that and then the evolution of like Title nine and everything. But we're a much better place and where where we were many many years ago. But nonetheless, so we've got societal um pressures that are shaping body image, especially when it female and male, right, Because that's another thing. There's often this idea that eating disorders affect just the female population, but it definitely affects a male population, right, Yeah, And that's one of the most frustrating parts about UM kind of the phorical perspective of eating disorders, right is that UM it is it only affects women. It affects primarily white adolescent girls or or um younger women, and it just, I mean, it blows my mind. Like I even came into the research based kind of having that same misperception, UM. But obviously research has completely blown that up, right, Like we know that it affects people across you know, across ages demographics, like it can affect them equally, if not more so. UM and certainly with men in particular, Like I I did a panel a couple of years ago with a football player who throughout most of his career had been cheating disorder, and it was amazing to see some of the audience's reactions like, oh my gosh, I can't believe a guy, let alone a football player, would deal with this. It's like, yes, of course, you know, we this is not something that is unique to a very specific type of person or type of athlete, even so, you know, and and for men were starting to understand, especially in sport, that there are different kinds of pressures. Right, maybe too instead of lose weight per se, maybe have a more muscular and more toned body, or have a very very small percentage of body fat um and so those types of pressures can feel maybe a little bit different than what it might be for um, for female or women identifying athletes. So um, you know, there's certainly a lot of nuances that we're starting to understand, and unfortunately their research is you know, has been a little bit slow to kind of catch up with with the times to some extent. But I think we're really starting to realize, like the picture is not always the same, and it does affect people maybe equal or higher rates kind of depending on your context, who you are, your environment, your background, and your experiences and the types of pressures that you might be receiving. Um. And yet we still need to make sure that like these treatments are cognizant of those nuances and really can be effective in mitigating that risk and making sure that like the treatment is going to set you up for success and is going to be sustainable long term. Yeah. Right, and so let's take let's take the conversation a next step, because a lot of it is like really recognizing the signs and knowing what it looks like. Because if we don't know what we're looking for, we're totally going to miss it. And that wasn't part of my experience, um, you know generally because at the time that I was going through sports in high school, I mean, mental health was just kind of like this. It really wasn't that much of a conversation. And especially when it comes to eating disorders. Um, you know, I don't think a lot of the people around me knew what to look for. So let's kind of go through some of them and and make sure that we kind of are all aspects and we're not going to hit all of them. Mean, we don't have a lot of time, right, but you know it's, um, some of its restricted eating, some of some of it might be over exercising. What are some other ones that come to mind for you that we should watch out for. Yeah, so certainly there's the behavioral component, right, the restriction, the fasting, the dieting, the over exercising, vomiting after meals or misusing diuretics and laxatives. Um, there's certainly that kind of group of behaviors that we can look for. UM. From an emotional standpoint, oftentimes we'll see folks really have dramatic changes in their mood. So you might know someone who you know could and this is a thing that can be really complicated with eating disorders and certainly other um, you know, mental health concerns. UM. With the onset of adolescence, that tends to be a time where yes, of course we'll see changes in mood like that's part of being a human, and uh, we also see that as a really high risk time for specifically creating disorder onset. And so what people might initially perceive or think that, oh, that's just them being a little bit more moody, or maybe they're just a little bit more anxious and you know, kind of recognizing what it's like to interact with other peers their age and things like that, UM may actually be kind of hinting at some disordered eating and some concerns about how like their weight or their shape may be perceived, or just real dissatisfaction and like distress around how they look. UM. So certainly that's something to keep an eye out for. UM. But in terms of what people are saying and how they're thinking as well, Like we might we see a lot of concerns with how people how they're looking, right, especially in comparison to others. Um. Like I said, there can be a lot of like emotional distress around that, but in terms of how people are thinking about it, Like sometimes I will I will see folks who say, I spend eight nine percent of my day thinking about what I'm eating, how I'm looking, um, and and it just is NonStop. And so sometimes you know, you'll get glimpses into that when people might make cursory comments around I'm feeling you know, I'm feeling really heavy today, or like oh my gosh, my Leo just is like really not fitting today, right, Um, And what we might think is like, oh yeah, I mean that can kind of be a normalized common especially in sport, may actually be something that is kind of hinting at more underlying concerns. UM. So it is something to take seriously when people are talking about that and making those kinds of comments. UM. Certainly not something that we want to be normalizing, right. We want to take that seriously and make sure that if folks are talking about their weight or their shape and their dissatisfaction with that that you know, hopefully it is just kind of a one off common and it is just kind of a you know, maybe something they might be feeling just in that moment um, but it doesn't hold that much value. UM. So checking in with those folks and making sure that it isn't something bigger and it isn't something um more severe and intense is exceptionally important. So there's a lot of different things to look for. Um. You know, if there's a dramatic loss of weight, um, even in a short period of time, UM, that's something to be really concerned about and certainly get that checked out from either a physician m or kind of your typical go to healthcare professional. So yeah, there's a lot of different things to look for, but there's some of the big ones to keep an eye out for. I know, I'm putting you on the spot, aren't I was like, okay, let's listen all the factors in two minutes go. But yeah, I mean I think that was you did such an amazing job of like really trying to make it as comprehensive as possible, because it's like there's a behavioral element there's a physical element, there's a psychological element, there's an emotional element, which can be really hard to decipher. You're right talking about adolescents. I was a disaster as an adolescent, at least from my parents perspective. I hadn't amazing adolescence, but it was like World War three. So it's like, yeah, how are you going to be able to like decipher between just like a general shift in this teenage period versus some of the emotional evolution of what might be going on with UM with the earlier signs of UM an eating disorder. And it's funny when you were mentioning about like the internal dialogue. I I haven't thought about this in years, but I remember thinking at one point, like as I was going through my recovery and working with my therapist, I was like, is there ever going to be a moment in my life that I don't think about this the way I'm thinking about it? Like I was like, I felt like, is this ever gonna stop? Like? Am I ever just going to have like a peaceful internal dialogue where I don't obsess about this? And the answer to that is like, it can happen, but it takes certainly takes a lot of work. So I think my X question will be for the people around these individuals and maybe kids or adults whoever, maybe its parents, maybe it's coaches, Uh, support personnel, how do they intervene? This is a really difficult part because it's like, how do you approach somebody in the right way it may not be ready to change. Yeah, uh, I that's the that's a million dollar question I've been you know, I'm thinking about even just an instance somewhat recently, UM with you know, some folks who are just trying to help their kids get to treatment and it has just been an immense struggle and fight, and you know they're still not there yet. UM. So you know, all the best thing you can do is show up with empathy and compassion and just be there for them as a human. UM. One of the things we often talked about, like when we're doing UM seminars for coaches and like support staff, UM is you know, certainly approaching the athlete, uh, you know, in a in a somewhat personal space, right, so it's not more private, I should say, UM, so that you're not calling them out on the training room floor being like hey, I'm concerned about you. You know, I've seen them and that does not go well. UM, So starting with that is helpful. UM. But yeah, just showing up for them and saying like, hey, I'm recognizing that you know, you seem to be struggling a little bit or you know, I think this is really the only time to name if someone has lost weight because you're concerned about it, right, Like, I've noticed you've lost a little like a little weight and I'm worried about you, Right, that's the I think that is the only time in what your weight should ever be mentioned. Um. And or if you know you're noticing like some of these behaviors right that we've talked about, Um, I'm I'm hearing things, you know. I'm I'm noticing that you're like misusing loxatives or diet hills to try and potentially lose weight, and I'm really worried about you. UM. So starting with that and from there just checking in, you know, using like those statements I'm worried being neutral and compassionate with them. We don't want to judge them for that. Don't say like I can't believe you're doing that. That's so stupid. Uh, definitely don't want to head that direction. UM. But the more that you can kind of lean into your softness and compassion, the better. UM. When you're talking with that athlete or that person, UM, make sure that you have some resources in your back pocket, whether that's UM even something as simple as like the Natural Eating Disorders Association UH their website, they have hotlines, they have uh you know, recommended uh kind of referrals and providers in in local areas. UM. Even something as simple as that can be really helpful as a starting place. UM. But if you happen to be a little bit more connected, like as a you know, has an athletic department or something, being able to immediately direct that athlete to sports psychology, their mental health resources, UM, you know, even just their their team physicians, that can be a great starting point to get them to some professional who has knowledge of eating disorders or other other health and mental health concerns UM that they can assess for is essential. So be compassionate, be empathetic, be there for them, support them, provide those referrals, UM, and then most importantly follow up. Because we know that it takes folks with eating disorders many on average many years to get help. And yes, yeah, yes, um gosh, I it is one of the mental health concerns that can for some people take like a decade to get help. Um because they don't necessarily realize what's happening is actually harmful to them. It's so normalized in some of these communities. UM. But also because it can be so congruent with how they view themselves or even like their performance, like they see it as something that's so beneficial to their performance when long term, like you're at much greater risk of getting injured, you might have a lot of long term health consequences um as a result of this, and certainly your mental and physical performances will suffer eventually, like it will happen. UM. So yeah, it's it's for some reason one of the one of the things that just takes people a while to recognize to be willing to get help. UM. So the earlier that we can catch it, the better. Yeah, it's a UM I know we're running out of time here, but yeah, I think you know, in terms of like intervening, definitely don't want to go in blaming there seems to be for me being on the receiving end, of it, there seems to be it seems to drop a lot of like internal emotions. You know sometimes I think, I'm sure people get frustrated. It might even bring up their own internal issues about weight and body image. And so when that dialogue happens, You're right, it really has to come from a neutral, compassionate, uh perspective. And uh so you know, if there was one takeaway and draw this question out to give you time to think about it, if there's really one takeaway at least in this juncture of your research, evolution and clinical training, if there's really like one or two tech aways that you want people to take um to absorb from this conversation, what would that be in terms of like athletes and eating disorders? Oh gosh, sorry. And it's funny because I've been asked that question so many different times, and I feel like I give it answer every time because the more you should yeah, the more knowledge and perspective I have, It's like, okay, well that changes and for your today. No, I want to say everyone just needs to go to therapy, but no, but I I you know, in my heart of hearts, like I think the more that people take this seriously and The more that people become educated, like truly educated from the the more that we can take this seriously and become an educated community as a whole, um, the better outlook we have in terms of changing this culture in sports. Like for me, I think, you know, if if I could, if I could leave some impact in in my second career, you know, as as a clinical psychologist um and not so much as an athlete. UM, if I could leave any impact, it would be moving the needle a smidge with the culture around mental health and needing disorders in sport. UM. And I think the education piece, the the overall empathy and awareness and compassion that we have UM, towards ourselves and towards others in this community. UM, the better chance we have at reducing the stigma around these concerns and really getting people to get help when they need it. Yeah. Well, the good news is, in case you haven't already realized that needle, you have already been been moving, not only from your outreach and involvement, but the clinical training, the research, the writing, everything that you're doing is truly moving the needle. So UM, it was fun being able to talk with you today and also collaborate with that with that chapter, and I hope we can stay in touch and continue collaborating over time, especially you know, two athletes in this space is amazing and we need more people. So Rachel, thank you so much for your time. I know you've got to run because you have so much to do it, but thank you so much for coming on and being so open and and really sharing your story and educating everybody. You bet, thank you so much again for all that you're doing too, because this is not an easy place to be and yeah, just very grateful for who you are and what you're doing. So thank you, thank you really hope you enjoyed today's conversation. For more episodes, just visit our show page on I Heart Radio or wherever you get your podcasts, and also to watch the full version of these interviews, you can head on over to YouTube just search for the show name. The next chapter with Prims Rippa Pat. Of course, subscribe to us like us, give us a star rating because we really appreciate you listening and also showing your support, and you can also follow me on all the social media platforms including Twitter and Instagram at prim Underscores Rippa Pat. The next chapter with Primis ripa pat is a production of I heart Radio. For more podcasts from my heart Radio, visit the i heart Radio app, Apple podcast, or wherever you get your podcasts. B b b b

The next chapter with the premise ripa Pad is a production of I Heart Radio. Hey Everybody, it's Prim. Welcome to the next chapter, presented by Baron Davis and Slick Studios. So this week's topic, we're going to focus on a topic rather than a okay, three three to the next chapter with primis ripa Pad is a production of I Heart Radio. Hey everybody, it's Prim. Welcome to the next chapter, presented by Baron Davis and Slick Studios. This week we're going to focus on a topic, and the topic is about eating disorders and disordered eating behaviors among athletes. I'm actually currently co authoring a chapter in a soon to be published book on this topic, and one of the main contributors is a former Olympic figure skater, Rachel Flat, who was also a PhD Clinical psychology student at u n C. Now, some of you probably recall she's been a guest here on the next chapter, and in that conversation we talked about her retirement experiences as an elite app So if you haven't listened to it, definitely check it out. But this time around, I wanted to delve into her developing area of expertise which is eating disorders within the athlete population. As some of you know, this is a topic that's very important to me because I was one of those athletes that suffered from an eating disorder, and one that began shortly after I suffered a significant injury at seventeen years old, and it's one that I battled all the way into my early thirties. Actually, and as you'll hear from Rachel, this is one of the most difficult mental health issues to manage and navigate because of how long it takes the individual to get help and begin and also complete that recovery process. And so today what I wanted to do is really dive into this topic about athletes and eating disorders and not only dispel myths, but educate listeners on the warning signs of an athlete who might be struggling with this and also the typical course of this illness and what coaches, parents, and other athletics staff could do to help rather than harm, an athlete who is suffering from an eating disorder or disordered eating behaviors. And just so all of you know, by definition, eating disorders are mental illnesses because there are different types of eating disorders. So that's plural mental illnesses that are typically characterized by unhealthy eating patterns and weight control behaviors that negatively affect one's physical health and or psychles social functioning disordered eating behaviors, on the other hand, are a host or collection of at normal eating patterns that are actually quite common, but they do impair one's physical health, but they do not meet the clinical diagnosis of an eating disorder. So I just wanted to give you the definitions of both terms. And I thought it would be really helpful to talk to Rachel, not only because this is what she is researching and centering her clinical training around, but because she has experience of an app so she can speak from that perspective. And as a member of the United States Olympic and Paralympic Committees Mental Health Task Force, this is clearly something she's really passionate about and she knows a lot about. So without further ado, here's Rachel flat and so here we are. You've recovered, You're making this transition, and I find out so cool that you know, you and I have are kind of following a similar trajectory. You know, you're you go from elite sports and then now into the field of psychology, although you didn't you skip the whole part of spending eighteen years and media and broadcasting. You're You're much more efficient than I. It's a much more direct route of getting towards that. So, so how did you get there? I know that's a complex question because you're originally pre met but but why psychology and why clinicals like? Yeah, So I had started doing a little bit of research my senior year college UM with my former p I at IT Stanford, and he did a lot of work on UM digital mental health tools with a specific focus on eating disorders. But the project that I initially started on was, uh, this kind of staying fit, you know, keeping at risk kids in San Francisco physically engaged in activities, you know, helping them build some better nutrition habits, UM like sleep hygiene, just kind of hear some basic skills on how to kind of keep yourself healthy, UM to kind of prevent these higher b M I s later in life. And UM and he thought I would be a great fit. Knowing my athletic background. It sounds great, you know, this sounds really fun and UM and I was a biology major, so a lot of pieces to that project really spoke to me and and so I started working on that project and UM after retiring. After graduating, I took kind of a I don't know, a six months, eight months kind of gap before one of his one of the people in his lab reached out and said, hey, we have an opening. I know you're still on the bay and trying to figure out what's next, because I grabbed coffee with her and I was like, hey, guess what out of line to med schools, So I don't know what, and and she happened to find out that there was a position opening, and so I kind of re entered his his work and his lab through more of this digital eating disorder intervention lens and started working on a National Institute of Mental Health funded research project where we were delivering uh, kind of the very first stepped care intervention and prevention model that was gosh, we I don't know, it's almost thirty schools nationwide there were we screened thousands and thousands of women, and we were able to kind of see pretty amazing effects almost similar to what we would typically see with in person eating disorder treatment, UM, just through this digital app. And I was like, my mind was blown. I was so excited that I just saw so many applications um to the tremendous gap and resources in the sports world and um, so yeah, So I got really excited about that, recognized that we could really use something like that in sports, and especially in skating because eating disorders and disorder eating and poor body image or just so so common and um and so that got me really excited and that kind of lit my fire again. And so yeah, I ended up deciding to apply to graduate school and pursue clinical psychology so I could balance kind of this research and the clinical practice and even the advocacy work um that comes with with this, you know, kind of this education and um yeah, and it just was so interesting to me. I loved the idea of having a multiple, multiple different career paths that I could pursue, and um yeah. So I jumped right in, got connected with my current PhD advisors, Innibiolic, and turns out she has a background in skating. She's been a life while skater herself, and so there were just so many overlaps for us that I was like, yeah, I can't not pursue this. And here we are five years later, I'm playing for internship and almost done with this process, and it's kind of hard to believe that this has all come together. And I'm really grateful that I went through those experiences now because it's really informed and motivated this work for me um. But I yeah, I really couldn't have gotten to this place without having gone through that. It's amazing and congratulations and all the success and work, and I feel like it's like one of those weird things where it's like for for us going through the doctoral program, I guess it's like one of those things you don't really get the congrats until your license or something. It's such a long process, like we deserve because you deserve a congrats, like in the middle, like you're almost done and you've and you've gone through all the hard stuff and the work now is hard. I know it's stressful, but really like that hard personal inner work was like beforehand, and you know now you're like offen running. So I really want to dive into this topic because this is one that really hits me on a personal level. And I've been some I've been public about this, and I've mentioned this in other interviews, but for me being a tennis player, and then, um, you know, I experienced a pretty significant injury. I had a couple of stress fractors at seventeen, right before I was being recruited, and it really prompted, uh, what began as kind of an eating disorder. And although I never was clinically, UM, I was never really diagnosed because I wasn't meaning with therapist at the time. But it's one that affected my life really on and off through my late teens and then into my twenties, and then of course definitely when I retired. Uh, it came at a full vengeance and it was the reason why I went to therapy. So this is a topic that I'm very, very passionate about. Um. So I'm trying to figure out where to begin. But you and I were in the process where in the process of writing and co authoring a chapter on athletes and eating disorders and disordered eating, which is so exciting. So, um, you know, the first question is our athletes more susceptible to eating disorders and disordered eating behaviors. Let's begin with that. What are your thoughts? Sure? Well, before I get to that, I want to first say thank you for being open about your experiences, because I think that in and of itself can normalize like getting help talking about mental health publicly and privately, you know, with people who love you most. So I just yeah, very appreciative that you are willing to share up with so many people. So, but to answer your question, UM, I think we athletes are at least as susceptible to develop a needing disorder, if not more so. And I think it's really context dependent. UM. There are certainly some sports like figure skating, like gymnastics, UM, like long distance running, where are there is this perception that being thinner or even if there's a weight class kind of like wrestling, UM, where there may be very real pressures to maintain or lose weight and UM. And so sometimes there's this perception that you know, being thinner maybe providing some kind of performance enhancement UM or advantage. And when that's not always necessarily the case, and in most cases it's not surprised, UM. But it is in those types of sports where we tend to see much higher levels of eating disorders and disordered eating and concerns about you know, your your body and your weight and your shape. So UM, there's some evidence out there that even competing at a high level in sports can increase that risk. It's a little bit missed, um, but I think more often than not, being at a high level of competition and sport can increase that at risk inpparently because you're you know, you might be interfacing with a lot of different people who are giving you a lot of different pieces of advice. And you know, I think back to my own skating career where the more I kind of rose through the rinks, the more pressure I got, and the more feedback, like direct feedback I got on how I looked my weight, how my costumes looked, how I should have used different types of costumes to hide my physique. Um, And yeah, I'm you know, even I think back to a lot of experiences that I've heard from friends and peers and athletes who are still kind of going through that pipeline, and it's just amazing to me that those kinds of comments are still put out there. Um, So those culture around that is starting to change now that people are being more open and frank and honest about their experiences. Um. But yeah, I think they're they're certainly some sport contacts that definitely lend themselves lend itself to a much greater risk of developing an eating disorder. Yeah, and and you know, I didn't mean to put you on the spot. It is a very complex, uh answer. Uh answer is a complex UM question. And obviously the research is still kind of evolving and developing, and depending on what study you're looking at, UM, you're gonna get different answers. But I think, you know, if I were just offering taking off my like clinical hat and my research had I do think that for various reasons, I do think that the athlete population is certainly very susceptible to at least under this umbrella of um, you know, eating disorders or disordered eating behaviors. For various reasons. I think the stressors, especially in today's sports landscape is so different. There's just more eyeballs or social media. There's a social media alone. It's just like, I mean, just the amount of pressure and body image. So, you know, I want to talk about the factors and like really stripping this this UM this topic down and educating people who are are comeing out you know, from from various UM aspects so we can better understand this topic. Because I think, you know, sharing a little bit more about my personal experience. Sometimes there's this idea or this perception. Then it's like, okay, and eating disorder really begins with they just want to lose weight. They just want to be skinny, it's all, you know. But there's multiple factors that can kind of play into that. So you know, when I say that, is there anything that comes to mind in terms of like the contributing factors that lead to this? Yeah, I mean I agree that there is this general sentiment out there that the reason eating disorders happen is because people decide to lose weight and then they develop kind of these these harmful behaviors um that lead to kind of this long sustained eating disorder journey. UM. And that's certainly not always the case, but I think the sports environment can certainly contribute to that in many different ways. Like I said, you know, there's with with being a public figure, and you know, even I think about this and I'll deal to with n C double A athletes. You know, I'm so worried about what that might mean for athletes who are not only trying to physically be, you know, at a place where their body can perform the way they wanted to UM, but are now also pressured to convey a certain type of physical appearance UM that would garner them more followers, more influenced UH in that space, and I really worry and wonder about what those long term effects might be. UM. Certainly, I think from a financial perspective, so it can be so helpful for a lot of athletes and can really alleviate some of the burdens of that kind of participation. But yeah, I mean there's a lot of different roads we could go down, from social media factors to both infernal and external pressures to UM kind of keep a certain type of physique that is perceived to be the ideal physique for a sport. And certainly there may be certain types of bodies or certain types of physiques that you more often see, you know, me being a five to person, not a great basketball player. You know that just never that is never going to be the case. I'm right there with you at five. Yeah, but but I think you know, you look at like gymnastics and this whole revolution that they've had from UM athletes who tended to fit this certain type of mold of being really UM kind of spelt and toned Um, and now you see you know, you see powerhouses like Ali Raceman and Simmone Biles and Laurie Hernandez who have come through and completely changed the game to show that actually you can even be more successful when you're pushing against kind of the typical stereotypes. Um. So it's it's I think there's a lot of different things in the sports environment that can contribute to eating disorders or at least kind of increase the risk for it. But I don't think it necessarily comes down to just this idea around losing weight. Um. There's a lot more complexity to that. Yeah, and you just mentioned the societal pressures that impact that's kind of always evolving, you know, compared to I mean, I think, you know, around the eighties and nineties, I was a period when uh, females and sports was really kind of on the rise. So I benefited from that and then the evolution of like Title nine and everything. But we're a much better place and where where we were many many years ago. But nonetheless, so we've got societal um pressures that are shaping body image, especially when it female and male, right, Because that's another thing. There's often this idea that eating disorders affect just the female population, but it definitely affects a male population, right, Yeah, And that's one of the most frustrating parts about UM kind of the phorical perspective of eating disorders, right is that UM it is it only affects women. It affects primarily white adolescent girls or or um younger women, and it just, I mean, it blows my mind. Like I even came into the research based kind of having that same misperception, UM. But obviously research has completely blown that up, right, Like we know that it affects people across you know, across ages demographics, like it can affect them equally, if not more so. UM and certainly with men in particular, Like I I did a panel a couple of years ago with a football player who throughout most of his career had been cheating disorder, and it was amazing to see some of the audience's reactions like, oh my gosh, I can't believe a guy, let alone a football player, would deal with this. It's like, yes, of course, you know, we this is not something that is unique to a very specific type of person or type of athlete, even so, you know, and and for men were starting to understand, especially in sport, that there are different kinds of pressures. Right, maybe too instead of lose weight per se, maybe have a more muscular and more toned body, or have a very very small percentage of body fat um and so those types of pressures can feel maybe a little bit different than what it might be for um, for female or women identifying athletes. So um, you know, there's certainly a lot of nuances that we're starting to understand, and unfortunately their research is you know, has been a little bit slow to kind of catch up with with the times to some extent. But I think we're really starting to realize, like the picture is not always the same, and it does affect people maybe equal or higher rates kind of depending on your context, who you are, your environment, your background, and your experiences and the types of pressures that you might be receiving. Um. And yet we still need to make sure that like these treatments are cognizant of those nuances and really can be effective in mitigating that risk and making sure that like the treatment is going to set you up for success and is going to be sustainable long term. Yeah. Right, and so let's take let's take the conversation a next step, because a lot of it is like really recognizing the signs and knowing what it looks like. Because if we don't know what we're looking for, we're totally going to miss it. And that wasn't part of my experience, um, you know generally because at the time that I was going through sports in high school, I mean, mental health was just kind of like this. It really wasn't that much of a conversation. And especially when it comes to eating disorders. Um, you know, I don't think a lot of the people around me knew what to look for. So let's kind of go through some of them and and make sure that we kind of are all aspects and we're not going to hit all of them. Mean, we don't have a lot of time, right, but you know it's, um, some of its restricted eating, some of some of it might be over exercising. What are some other ones that come to mind for you that we should watch out for. Yeah, so certainly there's the behavioral component, right, the restriction, the fasting, the dieting, the over exercising, vomiting after meals or misusing diuretics and laxatives. Um, there's certainly that kind of group of behaviors that we can look for. UM. From an emotional standpoint, oftentimes we'll see folks really have dramatic changes in their mood. So you might know someone who you know could and this is a thing that can be really complicated with eating disorders and certainly other um, you know, mental health concerns. UM. With the onset of adolescence, that tends to be a time where yes, of course we'll see changes in mood like that's part of being a human, and uh, we also see that as a really high risk time for specifically creating disorder onset. And so what people might initially perceive or think that, oh, that's just them being a little bit more moody, or maybe they're just a little bit more anxious and you know, kind of recognizing what it's like to interact with other peers their age and things like that, UM may actually be kind of hinting at some disordered eating and some concerns about how like their weight or their shape may be perceived, or just real dissatisfaction and like distress around how they look. UM. So certainly that's something to keep an eye out for. UM. But in terms of what people are saying and how they're thinking as well, Like we might we see a lot of concerns with how people how they're looking, right, especially in comparison to others. Um. Like I said, there can be a lot of like emotional distress around that, but in terms of how people are thinking about it, Like sometimes I will I will see folks who say, I spend eight nine percent of my day thinking about what I'm eating, how I'm looking, um, and and it just is NonStop. And so sometimes you know, you'll get glimpses into that when people might make cursory comments around I'm feeling you know, I'm feeling really heavy today, or like oh my gosh, my Leo just is like really not fitting today, right, Um, And what we might think is like, oh yeah, I mean that can kind of be a normalized common especially in sport, may actually be something that is kind of hinting at more underlying concerns. UM. So it is something to take seriously when people are talking about that and making those kinds of comments. UM. Certainly not something that we want to be normalizing, right. We want to take that seriously and make sure that if folks are talking about their weight or their shape and their dissatisfaction with that that you know, hopefully it is just kind of a one off common and it is just kind of a you know, maybe something they might be feeling just in that moment um, but it doesn't hold that much value. UM. So checking in with those folks and making sure that it isn't something bigger and it isn't something um more severe and intense is exceptionally important. So there's a lot of different things to look for. Um. You know, if there's a dramatic loss of weight, um, even in a short period of time, UM, that's something to be really concerned about and certainly get that checked out from either a physician m or kind of your typical go to healthcare professional. So yeah, there's a lot of different things to look for, but there's some of the big ones to keep an eye out for. I know, I'm putting you on the spot, aren't I was like, okay, let's listen all the factors in two minutes go. But yeah, I mean I think that was you did such an amazing job of like really trying to make it as comprehensive as possible, because it's like there's a behavioral element there's a physical element, there's a psychological element, there's an emotional element, which can be really hard to decipher. You're right talking about adolescents. I was a disaster as an adolescent, at least from my parents perspective. I hadn't amazing adolescence, but it was like World War three. So it's like, yeah, how are you going to be able to like decipher between just like a general shift in this teenage period versus some of the emotional evolution of what might be going on with UM with the earlier signs of UM an eating disorder. And it's funny when you were mentioning about like the internal dialogue. I I haven't thought about this in years, but I remember thinking at one point, like as I was going through my recovery and working with my therapist, I was like, is there ever going to be a moment in my life that I don't think about this the way I'm thinking about it? Like I was like, I felt like, is this ever gonna stop? Like? Am I ever just going to have like a peaceful internal dialogue where I don't obsess about this? And the answer to that is like, it can happen, but it takes certainly takes a lot of work. So I think my X question will be for the people around these individuals and maybe kids or adults whoever, maybe its parents, maybe it's coaches, Uh, support personnel, how do they intervene? This is a really difficult part because it's like, how do you approach somebody in the right way it may not be ready to change. Yeah, uh, I that's the that's a million dollar question I've been you know, I'm thinking about even just an instance somewhat recently, UM with you know, some folks who are just trying to help their kids get to treatment and it has just been an immense struggle and fight, and you know they're still not there yet. UM. So you know, all the best thing you can do is show up with empathy and compassion and just be there for them as a human. UM. One of the things we often talked about, like when we're doing UM seminars for coaches and like support staff, UM is you know, certainly approaching the athlete, uh, you know, in a in a somewhat personal space, right, so it's not more private, I should say, UM, so that you're not calling them out on the training room floor being like hey, I'm concerned about you. You know, I've seen them and that does not go well. UM, So starting with that is helpful. UM. But yeah, just showing up for them and saying like, hey, I'm recognizing that you know, you seem to be struggling a little bit or you know, I think this is really the only time to name if someone has lost weight because you're concerned about it, right, Like, I've noticed you've lost a little like a little weight and I'm worried about you, Right, that's the I think that is the only time in what your weight should ever be mentioned. Um. And or if you know you're noticing like some of these behaviors right that we've talked about, Um, I'm I'm hearing things, you know. I'm I'm noticing that you're like misusing loxatives or diet hills to try and potentially lose weight, and I'm really worried about you. UM. So starting with that and from there just checking in, you know, using like those statements I'm worried being neutral and compassionate with them. We don't want to judge them for that. Don't say like I can't believe you're doing that. That's so stupid. Uh, definitely don't want to head that direction. UM. But the more that you can kind of lean into your softness and compassion, the better. UM. When you're talking with that athlete or that person, UM, make sure that you have some resources in your back pocket, whether that's UM even something as simple as like the Natural Eating Disorders Association UH their website, they have hotlines, they have uh you know, recommended uh kind of referrals and providers in in local areas. UM. Even something as simple as that can be really helpful as a starting place. UM. But if you happen to be a little bit more connected, like as a you know, has an athletic department or something, being able to immediately direct that athlete to sports psychology, their mental health resources, UM, you know, even just their their team physicians, that can be a great starting point to get them to some professional who has knowledge of eating disorders or other other health and mental health concerns UM that they can assess for is essential. So be compassionate, be empathetic, be there for them, support them, provide those referrals, UM, and then most importantly follow up. Because we know that it takes folks with eating disorders many on average many years to get help. And yes, yeah, yes, um gosh, I it is one of the mental health concerns that can for some people take like a decade to get help. Um because they don't necessarily realize what's happening is actually harmful to them. It's so normalized in some of these communities. UM. But also because it can be so congruent with how they view themselves or even like their performance, like they see it as something that's so beneficial to their performance when long term, like you're at much greater risk of getting injured, you might have a lot of long term health consequences um as a result of this, and certainly your mental and physical performances will suffer eventually, like it will happen. UM. So yeah, it's it's for some reason one of the one of the things that just takes people a while to recognize to be willing to get help. UM. So the earlier that we can catch it, the better. Yeah, it's a UM I know we're running out of time here, but yeah, I think you know, in terms of like intervening, definitely don't want to go in blaming there seems to be for me being on the receiving end, of it, there seems to be it seems to drop a lot of like internal emotions. You know sometimes I think, I'm sure people get frustrated. It might even bring up their own internal issues about weight and body image. And so when that dialogue happens, You're right, it really has to come from a neutral, compassionate, uh perspective. And uh so you know, if there was one takeaway and draw this question out to give you time to think about it, if there's really one takeaway at least in this juncture of your research, evolution and clinical training, if there's really like one or two tech aways that you want people to take um to absorb from this conversation, what would that be in terms of like athletes and eating disorders? Oh gosh, sorry. And it's funny because I've been asked that question so many different times, and I feel like I give it answer every time because the more you should yeah, the more knowledge and perspective I have, It's like, okay, well that changes and for your today. No, I want to say everyone just needs to go to therapy, but no, but I I you know, in my heart of hearts, like I think the more that people take this seriously and The more that people become educated, like truly educated from the the more that we can take this seriously and become an educated community as a whole, um, the better outlook we have in terms of changing this culture in sports. Like for me, I think, you know, if if I could, if I could leave some impact in in my second career, you know, as as a clinical psychologist um and not so much as an athlete. UM, if I could leave any impact, it would be moving the needle a smidge with the culture around mental health and needing disorders in sport. UM. And I think the education piece, the the overall empathy and awareness and compassion that we have UM, towards ourselves and towards others in this community. UM, the better chance we have at reducing the stigma around these concerns and really getting people to get help when they need it. Yeah. Well, the good news is, in case you haven't already realized that needle, you have already been been moving, not only from your outreach and involvement, but the clinical training, the research, the writing, everything that you're doing is truly moving the needle. So UM, it was fun being able to talk with you today and also collaborate with that with that chapter, and I hope we can stay in touch and continue collaborating over time, especially you know, two athletes in this space is amazing and we need more people. So Rachel, thank you so much for your time. I know you've got to run because you have so much to do it, but thank you so much for coming on and being so open and and really sharing your story and educating everybody. You bet, thank you so much again for all that you're doing too, because this is not an easy place to be and yeah, just very grateful for who you are and what you're doing. So thank you, thank you really hope you enjoyed today's conversation. For more episodes, just visit our show page on I Heart Radio or wherever you get your podcasts, and also to watch the full version of these interviews, you can head on over to YouTube just search for the show name. The next chapter with Prims Rippa Pat. Of course, subscribe to us like us, give us a star rating because we really appreciate you listening and also showing your support, and you can also follow me on all the social media platforms including Twitter and Instagram at prim Underscores Rippa Pat. The next chapter with Primis ripa pat is a production of I heart Radio. For more podcasts from my heart Radio, visit the i heart Radio app, Apple podcast, or wherever you get your podcasts. B b b b