Big Ideas In Eating Disorders

B. Timothy Walsh, MD, FAED, is the William and Joy Ruane Professor of Pediatric Psychopharmacology in the Department of Psychiatry at Columbia University, where he founded the eating disorders research program at the New York State Psychiatric Institute/Columbia University Irving Medical Center. A pioneer in the field, Dr. Walsh has served as president of both the Academy for Eating Disorders and the Eating Disorders Research Society, and he chaired the Eating Disorders Work Group for both DSM-IV and DSM-5. His work has been recognized by the American Psychiatric Association, the Academy for Eating Disorders, the National Eating Disorders Association, and the Association for Behavioral and Cognitive Therapies. In this episode, Dr. Walsh shares a big idea that is also a simple one. Eating disorders are defined by disturbances in eating and eating-related behavior, so progress depends on studying those behaviors directly and objectively. That is how we will build more effective prevention and treatment. Dr. Walsh takes us behind the scenes of this research and explains how a clearer picture of the biology behind these behaviors, across eating disorders, will transform the way we approach them.

Anne E. Becker, MD, PhD, SM, is Dean for Clinical and Academic Affairs, Maude and Lillian Presley Professor of Global Health and Social Medicine, and Professor of Psychiatry at Harvard Medical School. She is founding and past Director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. A medical anthropologist and psychiatrist, she studies the social and cultural mediation of body image and eating disorder risk, social barriers to care for mental disorders, and school-based mental health promotion. Her landmark research on the impact of rapid social transition and media exposure on eating pathology in Fiji reshaped how the field understands the social roots of these illnesses, and her leadership has been recognized with the Price Family Award for Research Excellence from the National Eating Disorders Association and the Leadership Award in Research from the Academy for Eating Disorders, of which she is a past president. Professor Becker joins us for this fifth episode in our Big Ideas in Eating Disorders series featuring contributing authors to the book that Dr. Ruth Weissman and I co-edited. In Chapter 5 of Weissman and Pike's Big Ideas in Eating Disorders, Becker takes on one of the field's most durable shorthand explanations: that "culture" causes eating disorders. For decades, cultural explanations have been invoked broadly and often imprecisely, flattening the complex social worlds in which people live into a single variable. Becker argues that this culturalist framing has outlived its usefulness, and that the field needs a more refined understanding of culture that carefully examines how social environments, structures, and inequities actually shape who becomes ill, who is recognized as having an eating disorder, and who receives care. That reframing has real consequences. Drawing on decades of research, including her pioneering fieldwork in Fiji, Becker traces how social forces operate on eating disorder risk in ways that are more specific, more measurable, and more actionable than "culture" at a high level can capture, and she makes the case for what a socially informed science of eating disorders would make possible for prevention, identification, and treatment around the world. Join us for a behind-the-scenes conversation with Anne as she unpacks her chapter, the science and fieldwork behind it, and what it means to take society seriously in understanding eating disorders.

Laura Berner, PhD, is an Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, where she directs the Center for Computational Psychiatry and the Neuroscience of Eating and Associated Pathology Research Program. She is also a principal investigator at the Center of Excellence in Eating and Weight Disorders. Dr. Berner earned her bachelor’s in psychology from Princeton University and her PhD in clinical psychology from Drexel University. In this episode, Dr. Berner expands on the big idea she and co-author Riley Macks put forward in their chapter of Big Ideas in Eating Disorders, which I co-edited with Dr. Ruth Weissman. Her early work with rodents in Dr. Bart Hoebel’s lab raised the question that still drives her: what is the loss of control at the heart of binge eating, and how can understanding it lead to better treatment? Today her lab measures that loss of control using models of how people weigh costs and benefits. What calculations do people make before a binge, and how do those calculations shape whether they can resist? Dr. Berner makes the case that understanding this process could transform our ability to deliver more precise and effective care.

Kelly Klump, PhD, is a professor of psychology at Michigan State University whose research explores the genetic and biological risk factors for eating disorders. She received the Leadership Award in Research from the Academy for Eating Disorders and served as its president from 2007 to 2008. Her colleague Kristen Culbert, PhD, is also on the psychology faculty at Michigan State and is co-principal investigator of A Twin Study of Mood, Behavior and Hormones in Males and Women’s Health during Midlife. Their chapter in Big Ideas in Eating Disorders examines the vital link between women’s reproductive health and eating disorders. They argue that understanding why eating disorders differ in prevalence between the sexes is key to improving how we explain, prevent, and treat them. In this podcast, Professor Klump sets the stage for the chapter, explaining how fluctuations in estrogen, progesterone, and testosterone, especially during puberty, influence the onset and course of eating disorders. To learn more about their pioneering work, which promises to deepen understanding and improve treatment regardless of sex or gender, read their chapter in Big Ideas in Eating Disorders, co-edited by Dr. Ruth Weissman and me.

Scott Griffiths, PhD is a body image and physical appearance researcher at the University of Melbourne. He leads the Physical Appearance Research Team as an NHMRC Senior Research Fellow. Roisin McNaney, PhD, a cross-disciplinary digital health researcher directing CSIRO's Next Generation of Graduates program in AI and Mental Health. They are combining their expertise to explore whether social media -  particularly TikTok's -  can be repurposed for eating disorder screening. Their work transforms the discussion on social media and mental health. Drs. Griffiths and McNaney have contributed a chapter to Big Ideas In Eating Disorders (Weissman & Pike, editors) that is tremendously thought provoking and forward looking. They share highlights from their research that is built on a bold and visionary question about the use of social media. Their work comes amid growing efforts in Australia to restrict social media access for vulnerable youth, including the Online Safety Amendment banning under-16s from social media. Scott and Roisin are exploring whether an opportunity exists to use social media to actually improve mental health rather than only restrict access. They want to genuinely understand and address the underlying risks these platforms pose AND exploit their potential for good. Their central insight flips a common concern on its head. Rather than treating recommendation algorithms purely as a threat, they see the rich, passively generated data these platforms already produce as an untapped opportunity — one that could enable personalized eating disorder screening at a scale and precision current methods can't match. Join us to hear more about their big idea, and you can read the full chapter in the Big Ideas In Eating Disorders (Weissman & Pike, editors).

Stuart B. Murray, PsyD, PhD, is the Franklin Mint Professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA, where he serves as Director of the Eating Disorders Program and Director of the Translational Research in Eating Disorders Laboratory. His lab is dedicated to elucidating the mechanisms of symptom remission in eating disorders, developing novel treatment interventions, and advancing the recognition and treatment of male eating disorders. Professor Murray joins us for this third episode in our Big Ideas in Eating Disorders series featuring contributing authors to the book that Dr. Ruth Weissman and I co-edited. His chapter co-author, Jason Nagata, MD, MSc, is Associate Professor of Pediatrics at the University of California, San Francisco, where his research focuses on eating disorders and body image in boys and young men.   In Chapter 3 of Weissman and Pike's Big Ideas in Eating Disorders, Murray and Nagata confront a blind spot the field has carried for decades: eating disorders in boys and men. For generations, the science, the screening tools, and the treatments have been built around girls and women, leaving millions of boys and men underdiagnosed, misunderstood, or invisible altogether. Muscularity-oriented disordered eating, they argue, doesn't just look different; it demands a different lens entirely.   That gap has real consequences. Murray and Nagata trace how diagnostic frameworks calibrated to thinness can miss the drive for muscularity at the heart of many boys' and men's struggles, and they make the case for what it would take, from research to screening to treatment, to build a field that sees all of its patients.   Join us for a behind-the-scenes conversation with Stuart as he unpacks the chapter he co-authored with Jason Nagata, the science behind it, and what it means for the boys and men the field has too often overlooked.

William Sharp, PhD, directs the Pediatric Feeding Disorders Program at Emory's Marcus Autism Center, where he's also a Professor in the Division of Autism and Neurodevelopment in the Department of Pediatrics. Kathryn Peterson, PhD, BCBA-D, is a professor at Rutgers Robert Wood Johnson Medical School. Professors Sharp and Peterson join us for this second episode in our Big Ideas in Eating Disorders series that features contributing authors to the book that Dr. Ruth Weissman and I co-edited.   In Chapter 2 of Weissman and Pike's Big Ideas in Eating Disorders, Sharp and Peterson tackle a diagnostic puzzle hiding in plain sight. Two conditions, Pediatric Feeding Disorder and Avoidant Restrictive Food Intake Disorder, are both used to describe eating disturbances in children, and they overlap so heavily that clinicians are often left guessing which one actually fits.   That confusion isn't just academic. Will and Kate trace how the field ended up with two overlapping categories instead of one clear path forward, and make the case that untangling them is essential to improve treatment. Get the diagnosis wrong, they argue, and the treatment doesn't just fail. It can make things worse.    Join us for a behind-the-scenes conversation with Will and Kate as they unpack the chapter, the debates that shaped it, and what it means for the kids caught in the middle.

Phillipa Hay MD, DPhil, is Chair of Mental Health, Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales and the Director of Mental Health Research at Southwestern Sydney Local Health District. Dr. Hay is an academic psychiatrist who is recognised internationally for her expertise in reducing the personal and public health burden of eating disorders and obesity. Deborah Mitchison, PhD is Associate Professor in Psychology at the Graduate School of Health at the University of Technology Sydney. Professor Mitchison also holds adjunct appointments at Western Sydney University and Macquarie University.  Drs. Hay and Mitchison’s chapter in Big Ideas In Eating Disorders poses a big and provocative idea: What if we completely reimagined how the field classifies and diagnoses eating disorders? They argue that the current diagnostic frameworks are confusing and limited in practice, and they strongly advocate that the field will be better served by understanding the defining features of an individual’s eating disorder and the unique constellation of symptoms as experienced by the individual. In this podcast, Dr. Hay elaborates on these core ideas and what they would mean in real-world practice.

Professor Phillipa Hay is a psychiatrist and the current Chair of Mental Health at Western Sydney University in Australia, the co editor-in-chief of the Journal of Eating Disorders, and past recipient of the Lifetime Leadership Award from the Australia New Zealand Academy for Eating Disorders. Drawing on her experience from decades of teaching, research, and clinical care in eating disorders, Dr. Hay discusses the limitations of weight-based criteria in eating disorder diagnostic criteria, both in terms of limiting treatment access and in restricting our understanding of recovery.

Today we have the good fortune to hear from Dr. Kelly Klump whose contributions to the field of eating disorders are indeed invaluable. Inspired by one of her early mentors, Professor Gloria Leon, Dr. Klump has embarked on a journey of groundbreaking research that reshapes our understanding of the complex interplay between genetics, hormones, and environmental factors in the development of eating disorders. Dr. Klump’s exploration of gonadal hormones, including estrogen, progesterone, and testosterone, is steadily uncovering the relationship of hormonal fluctuations, particularly during puberty, to the onset and expression of eating disorders. Translating these findings to clinical practice has the potential to inform more effective prevention strategies and personalized interventions for individuals at risk of developing eating disorders.