PSICÓLOGO FELLIPE AUGUSTO (TRANSTORNOS ALIMENTARES) - PODPEOPLE #184

[Music] [Music] [Music] [Music] [Music] our guest today is a psychologist specializing in eating disorders. He works in the care of patients with anorexia and avoidant restrictive eating disorder. In addition, he is involved in research on the subject and coordinates a support group for men with these conditions in our chat today we will cover topics such as warning signs, the importance of psychological support, the impact of aesthetic standards on mental health and effective treatment strategies with you Felipe Augusto [Music] Hello everyone, welcome to another episode of pod people a place where we meet to see and

hear people People who Do People who happen People who inspire our guest today is a psychologist specialized in eating disorders the name his Felipe Augusto de Lima everything is good my dear how is it what a pleasure what a joy what a good thing Everything is good Everything is great welcome my dear the topic you are bringing up today which is eating disorders It was a much requested topic here and it was difficult find people and professionals who speak like this No, I just take care of that and I think it's a topic that's very

complex Uh, it's very complex So people think it's like that, ah, anyone can handle a compulsive eating disorder due to anorexia, so it's not even talked about, eh, it takes a lot of dedication a lot of knowledge and a lot of partnership with other good professionals I've always said this but before I start I wanted you to tell me a little about your journey and why you chose psychology and why then there are eating disorders, well I'm Felipe, I was born in São Paulo but I'm from coast I grew up on the coast on the

beach surfing almost a carioca located in São Paulo ex exact and the choice of Psychology was that I found everything very mysterious, right, I was like, wow, how is it possible for someone to understand another, how is it possible for someone to know these behavioral things at that time it was something very mystical for me so I went in the direction of studying psychology, applying to psychology at the time I took psychology Dentistry, the list for Dentistry came first I said oh, I don't think I'm going to do it, I held on a little longer

and it gave right, psychology Uhum So it was a great pleasure to do psychology, I think it's a course, wow, very cool, very good for me, in my case, in my life, it was very good, very revolutionary, and I'm still in love with psychology, working more and more, eh, and how many doors were opening, you know, in terms of partnerships, connection, so it was a wonderful course. Eating disorders came into my life because I really wanted to study a specific audience . I went to college when I was 17, so I thought I'm going to

leave college super young and what's it going to be like because people have that idea of ​​a psychologist as someone older, you know, that stereotype from Freud, I was wondering what it's going to be like for a super young person leaving university with a baby face baby what it's going to be like so there I was thinking about what I was going to work on specifically and I initially wanted something rarer at the time because I said well as I'm super young I'm going to work with something that's a little rarer So maybe someone will

give me some look at me and say ok I'll pass with this guy, very productive vision, right, assertive, comes from my family, they are businesspeople, everything also from my family, oh, I understand, I understand, so from there I had a class on eating disorders, it was specifically more focused on anorexia, I said, wow, maybe that's it, that's why I had never heard of it, it seemed like something extremely serious, it's something super serious, I said, well, I'm going in that direction so I applied for scientific initiation And then I spent some time waiting to do

the project, everything was approved And then I started a scientific initiation on anorexia nervosa, I went to the hospital to do the scientific initiation I spent a year with a mentor teacher, I couldn't, I just had to observe the data, I couldn't intervene or anything, I was a student, right, and it was really cool, it was about men with anorexia, and we managed to do it. some very good data in relation to Low prevalence, why the underreporting, I won a prize, a mission mon Rosa for those who are students, they win this Missão Rosa award

at a congress and from there the ambulim itself, which is the eating disorders program at USP, spoke Ok, there's this boy here, he did this work, he's here with us, he looks like he's interested, he's dedicated and I've continued there, I've been there for 10 years at the ambulim, it's been a long time and today it's like this, I see myself working with this population for the rest of my life. say one thing Let's start by defining what eating disorders are, right ? food are important changes in ISO behavior with a high level of suffering,

mainly in three areas of life, weight, body and diet Uhum So these are people who lose freedom in relation to food choices, they live excessively controlling their weight and with many issues related to shape of body number on the scale fear of eating thinking excessively about food so we understand eating disorders when the person has lost freedom in relation to food choices and becomes stuck with life revolving around food the weight of food we understand In a few lines in this direction is a behavioral change and is linked to weight, body and food and there

is always a presence of altered self-perception, no, not always, not always, we will see this more greatly in nervous anxiety than this change in perception, distortion of the image, it is something very glaring where the patients are most of the time very emaciated and Then we look at that patient, if we didn't see the patient based on what he is saying, we will be sure that he is very obese, but when we open our eyes and see the patient, he is underweight and extremely emaciated, so There we noticed an important change in the image in

bulimia can happen - the disorders we defined which are anorexia nervosa which has this this this important change in the image then we have bulimia which may have changes but it is less than the distortion, right This change the way he You see if you come, they actually spend a lot more time trying to deal with the aspects related to losing control over something you ate and then trying to fix it, having an urgency to try to fix what you ate that you think you shouldn't have. I couldn't do it with many dietary rules ,

but the prevalence in terms of distorted body image and binge eating disorder is lower , where people end up eating in large quantities and eating in large quantities is an amount that another person wouldn't be able to achieve. bear it So it's not overeating, it's not repeating the dish is not about eating a little extra because now this word compulsion has become popular and sometimes people say the person I ate two sandwiches ready I didn't have a compulsion, I didn't have a compulsion because those who have a compulsion will rarely say it so openly so

why not and it's an almost unimaginable level of calories, exactly exactly and it's not always linked to eating all the time, there's a moment there when he does that, and then there's going to be this large amount that another person wouldn't be able to handle, eh, it was until the that what the Bia perhaps brought it up in that episode the person ate what they would eat in a week or a few days associated with a feeling of loss of control an impotence in stopping eating a feeling of complete failure of being unable to stop

So in compulsion, you know, the notion of binge eating we see these two elements as very strong and if there are fewer aspects of distortion, they are saying them almost as if there was no distortion but there is great suffering with the body, all three, right? I think there is suffering there, it is in everyone. bulemia anorexia and compulsion binge eating disorder but I think that in terms of severity hierarchy anorexia bulemia and perfect binge eating disorder Yes Yes these are the three main ones, right, they are the classics, we even include there are new

ones These are the classics, and now there is the okay avoidant restrictive eating disorder which is the old food selectivity disorder we will see more in childhood so for example queer those children who have difficulty have a low appetite eating often seems like an unpleasant task and they are not super sensitive to food cues so the family almost has to force the child to eat and this is a big challenge for parents, parents feel very guilty and it is not linked to just one food, right, no, we will have three subtypes in this avoidant restrictive

eating disorder First go be that low appetite, these children have a lack of interest in food and the parents are desperate, my son is not eating enough, my God, what do I do, then take him to the pediatrician, then take him to the nutritionist, so it is a great despair PR for the parents because the parents want their children eat well, right? So, PR parents are very desperate. So this is a subtype, another subtype will be children who have sensory hypersensitivity, how can I say that, children who have difficulty tolerating texture or smell sometimes? of

food eh, there are high levels of disgust, they feel sick, there are children that I serve, their taste buds are altered. There are children that I serve, who cannot go to the market because of the smell of the fruit, there are children who cannot tolerate the texture of that fruit, they say that it is very sticky, okay? there on the tongue they don't know what it does if it is thrown to the cheek if it is chewed if swallowed, right? I have a patient who says to me like this he is tiny he says I

don't know what gelatin is like what do I do with gelatin I chew it myself I'm going to swallow what I do with gelatin, right? So there's this sensory sensitivity, it's another subtype but in isolation because, for example, within autism spectrum disorder we have selectivity, it's comorbid or it can be comorbid, but to note, it's generally a separate one, which we exclude . all the other disorders so we can say that it is the exact restrictive avoidant disorder and the other subtype will be adolescent children and even adults that this can appear at any stage

of life, generally low appetite and altered sensitivity to food, we have seen it since very small six years old four years old from an early age and this other subtype that involves fear of aversive consequences are children who choked So they were eating something they choked on the fish bone they choked on the chicken they choked on something And then he and from then on They want to eat these foods more, they cut out, they even associate foods that have a similar composition and the parents are also very desperate because you have a very important

change in the child's eating pattern, very obsessive, right? has a profile of very high level of anxiety super super isn't it because everything you said is almost develops almost a phobia for that Uncle of food, right almost a food FOB ex and this selectivity we also see within a profile of more children super super anxious which will even be a big difference, for example in classic eating disorders anorexia bulimia TR of binge eating we will see more changes related to mood there may be some level of anxiety we see more prevalent aspects of mood more

depressive symptoms, right? more oscillation of this aspect of humor and the children who tried to see us see the strongest axis of anxiety and aspects related to being obsessed with food there the texture the way shape smell Rig a cognitive rigidity I remember eh I always used neuroimaging a lot, right Uhum And I once did neuroimaging on a patient with an eating disorder for a long time between 2010 and 2012 and I remember that the neuroimaging profile of anorexia was very similar to that of touching uhum obsessive compulsive disorder the profile of bulemia and binge

eating was very similar to the impulsivity profile of impulsive disorders, impressive, so it was clear that there were small differences, some also had more changes in the temporal lobe, but you always had something there of anxiety in the parietal lobe uhum Frontal at right, which was very similar, yes, right, we're even left with that question, isn't everything a spectrum? right, the big discussion The big discussion in psychiatry, right in psychology, and it caught my attention a lot, as well as this type of pattern, and it's not rare, for example, even in anorexia, you 'll see

patients who have a progression there, a comorbidity, a joint diagnosis with touch Deal obsession is And then borderline we will see there in bulimia conf bulimia more in confusion exactly we will see it very prevalent they stay there in the game, right, exactly has this prevalence What is the prevalence today in Brazil of eating disorders look here in Brazil, according to the Brazilian Psychiatric Association, it would be 15 million, exactly, we have 15 million, and in the world we are talking about 70 million, 70 million and we have to remember that this is under diagnosed,

exactly, so for example, when it is 15 million in Brazil I say that I play for double At least I'm perfect, yes, because then no one starts talking Uh, it's very difficult because they are disorders that people hide, hide, they are very ashamed, sometimes, sometimes we have to see a change in that person's behavior a person like him sometimes has this perception or even hides it, for example, I remember that patients when I saw patients who had bulemia, I always asked for information from the dentist uhum because it started to give acidity to the teeth

and I also observed the hands a lot. calluses to cause rç calluses this to cause vomiting the exact exact are good clues because the gastric juice is super corrosive and eats the patient's tooth enamel there It's not exact exactly so it was things and then it hit there 15 million, right? Within Brazil, within Brazil, and what you brought up is actually underreporting because there's a lot of stigma, they're very ashamed, they try to hide all of this as much as possible and it's not always visible because they start to hide their behavior, you know, so

they don't eat anymore in front of people, they avoid it in places where food is present, of course, perhaps in binge eating it can be a little more evident there in terms of eating patterns, right? And also if it is a patient who has anorexia, the issue of losing that weight in a frighteningly visible way of others until I think that There is something very wrong and there is, right, but people first associate it with this, maybe you don't have cancer, you don't use drugs, right? People start to say that, in principle. Including this report

Hi, the people at the eating disorders outpatient clinic, the outpatient clinic, That's our team, exactly exactly So, talk a little bit about this term, ambulim ambulim ambulim is USP's eating disorders program that started in 1992 if I'm not mistaken. There we have specialized programs So there's an outpatient clinic for anorexia, one for bulimia, one for binge eating disorder , one for men with eating disorders, there's one for childhood and adolescence, which is also cool, which has seen a huge explosion in the number of children and adolescents And then there's a mobilization a lot of the

family is involved in the treatment And we also have hospitalization, everything through the SUS, everything through the SUS. So people can sign up and have access to multidisciplinary treatment with a psychiatrist, psychologist, nutritionist and all the specialties they need, so it's very competitive, right? There's a lot of occupational speech therapy also exact dentist Dentists help us a lot this TR sure we're in doubt are you vomiting the dentist is you vomiting now change right for a long time like that it's logical that it can happen to anyone of any gender right but we had something

that used to be a thing that was more characteristic of women, what made you like this is more the female gender, what made you like that, okay, now you said that there is already this research group there, but it was already this thing that you also thought like that no I go one line more for eating disorders But You also caught this audience of men because it was more difficult for us to talk, right? Exactly, because it was rarer, reminiscent of that aspect of rare, I wanted it, it was rarer, or it was more hidden,

I always question myself, exactly, because women were always like that thing about women, this thinness was expected, this standard, this cult of beauty, right, it was even socially justified, this was good, it was something that wasn't if it was required and I don't think so if it wasn't noticed that this is an exact myth you were right on point This is the big myth right people believe that ah it's much rarer in men not necessarily if we come back even for example if we go back to the first reports of anorexia it was a case

of a girl and a 14 year old boy understands this in the world this history of anorexia in the history of anorexia the first reports of the doctor called Richard mor uhum and he brought these first two cases and within these cases, a lot of attention was paid to women because there was already a social justification linked to this and men, we noticed that they were excluded from the research, a large part of the research, if you go and see, it is written there, we are looking for young women such and such, they didn't even

let people say exactly independently . So men were excluded , so this already has an impact in terms of Diagnosis. similar between men and women , right? But overall, out of 10 people with eating disorders, four are men and six are women, so realize that they are very close, right? ago, it was said that 90% are women, 10% are men, today you are already saying that out of 10, six and less are already men, it has changed due to two elements, notari, and in children, the highest prevalence will be in boys, right, and in children,

of the compulsion are the boys of this avoidant avoidant disorder and the eating compulsion is very similar so in the outpatient clinic we of the boys This of children this oar in children and in adults the compulsion the compulsion is similar between men and women very similar so much so that there most of the patients are in the boys' clinic, most of them are people who are interested in food composition, then bulimi, and lastly, anorexia, it's just that we have new data that, for example, the dsm itself will bring that in adolescence anorexia nervosa has

similar rates between boys and girls, understand, so this whole aspect is being reviewed, especially because today men are also being greatly impacted by aesthetic pressure, not only are women more and more, and are ideally related to musculature, having a thin body, but that there is a specific musculature there, there are some different elements there, but there is an aesthetic pressure on the boys, also more and more, in relation to the issue of vigorexia of the musculature, it is much heavier than that of women, I even think that there is already a percentage of women with

vigor which is unimaginable uhum 30 years ago today you already see it but I think it's still rarer for men I think it's much more common exactly there in the hospital for example women they will say they don't want volume a lot of times in the body wants a very slim body, you know, and the boys will say that they want a slim body but with some visible muscles, some lines, some muscles there, we are already starting to see some differences with the very strong entry of Fitness bloggers, all of this we started the to

see a change in the behavior of women as it would no longer be enough to be thin, they would also need to have this toned muscular body, but always in this look of thinness, ah designed n drawn, we are seeing some changes, there were women, for example, with Mainly within the anoxia group who did not They wanted to gain muscle so as not to look like any type of muscle so as not to have a body volume that bothers them, they associate volume with fat and fat, so it's difficult to explain, no, you have to

have a minimum amount of muscle to protect your bones perfectly. because in anorexia you start to see signs of osteoporosis in very young teenage women So you need muscle mass and when you start to have a little muscle mass No, but I'm already getting fat I'm increasing in volume, the clothes no longer fit what I was actually putting on muscle but it wasn't fat there, right, perfect, that 's the big sign when a person starts to notice that the person is very thin and the speech always stays along these lines I'm big I'm fat I'm

bigger I can't stand being like this anymore and she can't see this lean mass thing and it's very difficult very difficult because she gets this feeling if she's bigger it's volume volume it's fat fat volume doesn't matter to her It's as if she had to see herself, right, and we see me, here in Rio, she even passed away, there was a woman we called her a white woman, she was all in white and she walked around and around Lagoa Rodrigo de Freitas Uhum And you literally saw the femor uhum it was something it gave a

sensation the exposed bones and she was compulsively looking for a caloric loss I remember people this woman had multiple fractures and it was something like that she was already a well-known figure but I was worried about that and there was one time when I was at a gym and she started going to the gym, the gym staff I was scared because she got on the treadmill, she went at a speed, a speed, a determination, an intensity that the gym arrived for her. you can't because you don't have muscles you could fall She ended up leaving

but no one put her out there and said look do you want guidance we have a nutritionist we she took it as a rejection a rejection is and B that's what you brought like a person who is malnourished, going to the gym, everyone around them realizes that there is something very wrong, everyone is worried and they end up not having this perception due to the image distortion, so they are trying to remove that discomfort related to the body and only Hold on, right, if we look at why the We see that in eating disorders they

end up doing things that other people wouldn't be able to do . so important so eating disorders are very worrying because of this they go far beyond what anyone would achieve and within the ambulim for example you separate by gender male gender female and depending on the exact disorders within the Separation for example eh a person who identifies as a man but identifies with the female gender he goes to is if he is a male trans man he stays with the gender a trans man stays with us in the clinic that trans woman stays with

the girls respects the issue, that's for sure what I wanted to know about this separation we made between treatment between men and women. Regardless of whether you are sis or transsexual, yes, it was because the boys already took a long time to get to treatment and when they got to treatment, they realized that there were only women, which put them off a lot. they felt very backward they were able to express themselves properly, they thought that women would judge them as cool or any other term along those lines, so this was very inhibiting and from

then on we started, we didn't, right, I arrived much later, in fact, from then on, my boss, right, mine bosses were organizing and realizing that well, we need to have a specific group for boys and something very interesting is that boys arrive very seriously and they recover much faster compared to women. Why do I think there is this gender crossover among boys? come together to leave of the disease, we don't see the competition that we ended up observing in the group of interested girls. So the boys come together in groups and even scold each other

to get out of the disease, self-help there, self-help at some times, at various times, we When we stay there in therapy, we take a step back and see the group working among themselves, so they take a while to arrive when they arrive at a place where there are several other boys suffering in the same way, they make this commitment to leave what you're doing interesting Speaking of, I didn't know about this, but I I think this goes back to the history of humanity, right? The men hunted together, right? They went out, the women stayed more,

organizing life, let 's say, social, right? very united, so much so that at the end of the treatment we are even mobilized because they came together and created a group even though they worked for a whole year together to get out of the disease, so that's what we noticed in the girls' group, they often have this aspect of comparison So if even the patient who starts to regain a little more weight, the others start to exclude ugly looks. So we have these difficulties, a very social pattern, we have this that works, right? This competitive thing,

right? I always said that, like women were. and socially educated to see each other as one competition a competitor of who is thinner who is prettier who is more intelligent men don't do that, we get this from history, right? Today, my grandmother, you know, has passed away for a long time, but my grandmother had my mother Eh, without a husband Uhum And she was literally included and my great-grandmother was the one who raised my mother, she threw my grandmother to them, they were from the countryside, so she threw my grandmother to the big city, like

disappearing and my mother was raised by by by my great-grandmother, right? let's say this for her grandmother because she can't I couldn't , now we don't see this story in men . They're chaotic, but they think it's all normal, you know, they think it's normal to mess up, shoes thrown around, I think that's what I say, people, I wish I had that, no, I said that, I wanted to have this lack of commitment or this lack of embarrassment in dealing with chaos and look at you as if nothing had happened easily, I don't think so,

and there was a time when I said something like this, people, this sorority thing, I'm sorry, women have to really go after it and I was even misinterpreted as if it were like that, oh, you're saying that women They're not united, I said, they shouldn't come together more and more and more and more and I'm like, be careful if I'm going somewhere, for example, I'm going out and I'm in the car, I see a show, for example, I see a woman who is alone waiting I always arrive you are going to Do you accept ride

hello, I'm not not mine, my chauffeur is here, do you want it because people look at it like that, right? Because I say gosh, if I were there, I would like the person to do it, but that's because I've always got it in my head like this, we women in some certain aspects we are more and target is you imagine leaving a show at Maracanã true that c Uh that Uber doesn't arrive taxi doesn't arrive you have to walk something there which is a difficult environment I always look and see and offer you understand but

I don't I see this as a rule and I'm sad because That's how it is and now you're saying this and I confirm it a little bit, right? And that's why there in the girls' outpatient clinic What we did, right? We kept them in a group and we didn't separate them, even with the aspect of competition and everything. this so they can come together because in their lives they will have to be in groups with other women. So it was a big discussion and we had a consensus that we are not going to keep them

in groups so they can learn to come together and break these related patterns the competition to be better and things like that and it's been working well, you know, well, it's been working B group of women that works most of all is when they become mothers I think they turn the switch on, it's easier, interesting, and in eating disorders it's a protective factor, so many women who were very severe eating disorders when they are pregnant, it is a protective aspect, they improve their symptoms, yes, that was one of their biggest fears. I remember that there

were some women who became pregnant and it was already more difficult, depending on the severity, it is more difficult to get pregnant. because D is a minority, right? I stopped menstruating, right, and that's why it was so big, people were like, first thing is it possible, and second thing, what are the outcomes going to be like, right? And there was an improvement in symptoms. Oh, it's a protective factor, even socially, right? mother changes biology, right There is a change there that Positive I remember that once there was a patient who was married to a girl

and he was very worried because his wife didn't have milk and he was describing an option of things I said, I think his wife has anorexia Look, uh, what's up, but he had no idea, uh, he was just worried, he was like that, we waited so long, okay? ok ok ok ok And then I said we say I don't say but who is her doctor right because then I was getting involved I said no but what about her doctor who is saying ok ok ok there you want to talk to her doctor Bia because I

trust I said so much about you because I didn't get it then I said it dear here Ana Beatriz Look, I just wanted to, I'm not here to say anything, but because of my patient's concern, right? Hey, the child will really need milk, but I'm thinking there's some profile there of eating disorder AED said it like this Doctor profile is not the disorder I said but you should call the specialist, right the eating disorder because it is very difficult F he doesn't accept it I said it but it is as if you put it there

Try to go little by little because it is very complex because he was the obstetrician I was trying there and I said the hole is lower and sometimes if you make the connection, right, the importance for this child takes this turn exactly, it's a protective aspect now an interesting thing that you were talking about but obesity also has a factor eh I worked and still work for a long time with bariatric surgery and we have to warn a lot right after the surgery, some women today no longer do so, but at the beginning of bariatric

surgery we had this profile of pregnancies like 3 to 4 months after surgery because of this reduction and This was a lot of concern because you don't have it and it's Total vitamin, right, you're losing a lot, imagine for you having to feed yourself and feed another Zinho, a little being there, so for a while, we, at conferences, we talked a lot about this, this concern about guiding because it was Turn the key very quickly, yes, and that is, it is worrying, right ? of eating disorders This is the great care ISO because you turn

it on one side this is the great care and that's what the person often does, because typically in obesity treatments, depending on the shape and form, it's very delicate, right, so the person ends up compensating for what they ate. calories, right, the person stays there excessively controlling their weight, it's a very fine line and that's why you need to have a team, have a specialized professional because it's a fine line, you're complex, you can change things there, you understand, it's complicated, yes, yes, other types of compulsions, n others types and comorbidities Also, right? What are

the most common comorbidities in eating disorders ? Do you want to describe them in general, as you think is best? Anorexia ? also have substance abuse These are the most prevalent, okay When we go Let's go to bulim the binge eating disorder comes in very impulsive disorders in the whole story so borderline personality disorder pathological gambling substance abuse among others excessive shopping we notice this a lot At the outpatient clinic, okay, we'll see a higher prevalence of anxiety disorders, more anxiety disorders that we'll see touch. We'll see it in a second instance, but it's much

rarer, and the interface that would be a differential diagnosis there with with you, you know, TDH we also see a lot in the tar TDH we see a lot more compulsion Funny, I with with TDH TDH compulsion compulsion also has compulsion also due to impulsivity due to impulsivity we see less there in anorexia and then when there is It's a little more delicate, but there's this, there's an avoidant, restrictive thing, there's Yes, we're talking about touch, I remembered, we already have it, there's a sensory thing, there's a sensory change, in hyperactivity disorder, there's not much

that's said about it, but there is. the sound thing texture thing smells label this is clothing label etia of R exact It's the children of L exactly and in the touch I only had Um, right, he still remains, he was Bia's patient and today he's still with me but we had a patient who arrived so skinny Uhum And his main problem was touching but it was very linked to food Uhum and he has now changed what he ritualizes right, it ends up becoming a food ritual because many things in anorexia have This aspect, right, the

way of eating the quantity, sometimes you don't want to Touch one food to another, but in anorexia the focus will be very related to this weight control, no one's touch to the sometimes adjustment, sometimes it's the same behavior but the motivation is out , right ? of help, guided self-help, I would like you to talk about this, it's my master's degree, exactly what topic in the master's degree that I found very interesting is it 's going to be a form, I mean your proposal, right, it's a proposal, no one is saying it's available , it's

going to be in the form of an application as it will be So abroad, when we think about guided self-help treatment, which is not yet widespread in Brazil, but abroad it is already much more talked about, it would be exactly for people who do not have the financial conditions or do not have access to a specialist or would perhaps not even need so many people involved in the case because they are subclinical symptoms, it's right at the beginning of the disorder itself. So it would basically be to help these people at first, right, so it's

a 13-week program, there are 15-week programs, there are 20-week programs, but it's much shorter Always accompanied by a clinical doctor or psychologist or nutritionist or some other trained clinician and he will have a program there that will be conducted, ok so they are normally and as if it were a book of high guided help and this patient will have meetings with a clinician and other meetings he will read those pages and return for consultation with the clinician and the Clinician will guide him along the way. The Clinician will realize that he is improving. The symptoms

are not improving, right? to starting by increasing the level of assistance because this patient is not responding so well, so it starts there, in the United Kingdom, this is quite widespread for binge eating, but this would be generally open to the public and you would have, as if it were a cut-off questionnaire in the research for to know who is in light mode, light ISS, right, that can be part of this in the research, we are going to recruit 80 patients Uh, who have some uncontrolled eating or eat, believe that they eat in an uncontrolled

way or something like that So it would be more for binge eating compulsion the first test will be compul there's no way because it's serious it's serious right away PR compulsion to get compulsion emotional eating overeating more for this audience so first thing They look for the hospital looking for a medical evaluation first moment to have the diagnosis having the diagnosis then they are randomized it's a term they are placed randomly in some group and within that group Some will receive care guided by a clinician and will receive a book and others will receive care

with a clinician and videos teaching the techniques when he If you have a craving for compulsion, you can open the video and follow the instructions. I understand, so the testing we are going to do in a master's degree is a 13-week program that has already been validated, it was with the people at Stanford, I have contact with the people there Anyway, I did the training, let's test it, let's see, but we are very optimistic, interesting, I think it's interesting, because there is no professional who can handle all the demand, not even one country in the

world, because there are people who talk like that, oh, Brazil, people are the world, there are many more people in need. of help is effective than professionals who are trained and even those who are trained are qualified, it is different when you have a trained professional who is not always qualified , so anything that also brings a little proactivity I find very interesting yes, and then the biggest results in the research were with clinicians specializing in eating disorders being guided by a clinician, because eating disorders are we seeing how serious it is and how much

this multidisciplinary team needs, everyone needs to be united, but there will be patients that TM is one symptom or another that often cannot be absorbed in large centers, they are no longer able to join a specialized team because there is little, so the idea is that we take care of this patient so that he does not transform, not having a complete diagnosis, you know, not having this evolution almost an exact prophylaxis, right? exact gravity, right? That way it enters the line of suspicion, we follow it and the Clinician next door notices that we are always

being guided, it's not pure self-help, there are pure self-help studies but the response is much smaller, much much smaller, so guided self-help, we won't see yet. how will it be accepted not only by patients but also by clinicians, as clinicians are sometimes not very resistant, they are resistant to high-aid treatments, so, but here, guided self-help, there will be a clinician Gui, something that transforms your life in 13 weeks, right? this thing this false advertising this false advertising C TR Semas, when you promise these healing things, you run away if you say it like that, the

industry doesn't want you to know that, it's also flawed because then they will discover that there is milk that is given by a genetically modified plant in the Himalayas then that little juice from that plant is capable of defeating bald people and I don't know that it does everything, it's a lie, people, it's because human beings want to believe in magical sun, they want to, but we are too complex, exactly, for magic to be able to take care of us, right? That's why this This would be the first step even for these people are already

being monitored and seen so they don't get worse and if and if we realize that it wasn't enough, then yes, let's put together the team, let's have a multidisciplinary team, let's organize this person, they will be assisted, right? So I think thinking about Brazil would be a way to start this work for people who don't have access to large centers, so for example there is an ambulim there in São Paulo, in Rio de Janeiro, there is a very strong eating disorders program, which is Gota da ufr daj, there is Apolinário José Apolinário, exactly, he was

one of the first there the bring this very strong, right, Mônica does not, Apolinário, wonderful, wonderful, Felipe, we, in the history of humanity, this issue of the body of the high image, we saw, right, men went out to hunt, women were considered, eh, women to marry so that we could have children the cult of that body, the obese body was a sign of health, right, no, not obese, but from the middle age of the middle age, bodies with more than that Exactly this blame then we come, we come, coming after the Industrial Revolution and and

now with the arrival of social networks too us see this change, what do you think, how does this affect the good and also the difficulty of the network in this competition for this exact thing, let's go back, let's get into the aspects of history, right, if we go back in history, at that time, people who had bodies with more shapes were people who had more access and were linked to success so people had financial conditions people had access to food to the point where the body had shapes and those people who had a very thin

body did not have access and therefore synonymous with women was considered healthy to literally generate children then This aspect is We even look at history, this element of Success has now been reversed, so the person who has this slim, muscular body is linked to this social success of the person also being able to take care of their body, doing this, doing that, going to the gym and things like that and This is having different consequences, you know, where people start to not question why these things happen and start getting into all these traps, so on

one side of the coin we see that the population is worrying a little more about their health, but eh, no The motivation is always based on health, it's based on aesthetics and that's when they start to get lost ex the mass effect, right the mass effect because in these aspects related to eh aesthetics the person starts to look at beauty standards becoming very contaminated with beauty standards that change from time to time and the body often won't keep up with that, the body isn't like modeling clay, oh, now it's like this, now like this, the

body won't keep up with all these changes and the beauty standards are constructed to be unattainable, right, so now Victoria Secrets has even returned, that show with the Angels, the models, models, which is very delicate, everything because even that name, right, is something inaccessible, those bodies, only the angels, only the TM angels so on social media even after this Vitoria Secrets thing they started Trends, right, from people after they watched Vitoria Secrets oh this week I'm only going to eat a certain food this week I start a diet So all of this is very delicate

because people end up being very contaminated, the herd effect that you brought, so on one side of the coin we see people taking care of their health a little more, but becoming much more susceptible to becoming dry due to aesthetic aspects and aesthetic pressure, diet culture will not forgive nobody nobody so if you are, even you talked about Pregnant Women, if you are a pregnant woman, you often have an aesthetic standard that when you have a baby, your belly won't be very big, when you had your baby already ready, your belly is organized, you know,

so the pressure on diet culture stoned, there aren't any who do that HD that Lipo HD in three months they're saying they didn't do it, it's visible that it was done, they understand clearly and the person doesn't know that it's fake news, right, it's fake news, perfect, since it's for me, it's me I tell you one thing Philip what if it's ugly that New is classified as something prohibitive uhum 90% of social networks uhum they're going to remove perfect material, big perfect, lives there are edited, right? We're going to have to be very careful because

this body is edited, it's altered in terms of procedure surgery and people look at it and say I want it too, I also want it, right, because somehow people want to feel like they belong, are special, accepted, right, and social media encourages this a lot, so these are the big dangers, right, even this negative belly story is a concept there from Vitória Secrets, right? And then people believe that when they sit down, the belly can't be folded and will have to be supported when we get the body, it's mobile, it's not plastic, right? Outside, you

see the Buddha, the Buddha had a big belly, the followers of Buddhism think it's cool, people with big fat people, the breath that Relaxes, you have to have a big belly, bar, you understand, yes, so people start buying into these ideals and with the advent of social networks This ends up being very dangerous, especially in adolescence, which is the period in which they are building their identity . adolescence is the phase in which one seeks group identity but I think there are people who are doing this, especially people who get married early and separate, oh

Jesus, you can identify in the gym what is separate and what is separate because you come with more hunger than the young you look like that you Tell me guys, I didn't have the Audacity to put on that outfit that I'm wearing, I tell everyone I'm doing muscle training today so I don't get osteoporosis uhum uhum so much so that when Personal starts a little bit I said remember that I came here just to maintain my health to maintain my physical health he said no, I remember that I said, for the love of God, it

has nothing to do with carnival, it has nothing to do with it and that's a good point, right? Many times when the person's motivation is based in aesthetics They can't have this consistency in a healthy way or they hate their body or they judge themselves, feeling guilty if they don't go and end up not having the consistency can be summarized as an aesthetic aspect, improves sleep, prevents mood, so many benefits sometimes end up being summarized as changing the body, shaping the body Exactly exactly, it's me, I have about two weeks, I don't know, but it

was me I should have painted the price you pay for your body Uhum And then I was saying that the age group between 30 years old and more or less developing diseases that would be more diseases for an elderly life, you know, of elderly people, why is it exactly that who was a teenager who is now in his 30s due to the excessive use of hormones and how much diseases that were diseases have increased, for example, today I see this, I see very young people in the gym with horrible back pain and then you say

so we have something wrong because for example I had surgery on my spine and I had a very serious hernia and I do exercises for the spinal muscles and when I'm doing them correctly I don't feel the slightest pain at all, nothing trapezius, nothing is perfect, something is wrong These people are doing something And then oooo Personal came to me and said, today , young people who are exceeding are having spinal changes that people would have at 70 or 80 years old. color If it's hurting like this, there's something wrong, certainly, excessive exercise and monitored

Malu is just as bad as his absence, exactly, exactly, and then for the teenager, it's almost as if Ah, that's what's going to save me. That's what I 'm going to do. I will be able to be successful, have a girlfriend, have this, have that, people will like me and then things start to go wrong, which is why these issues of physical activity are very delicate. Starting a diet is also something delicate that people today, diets don't are not based on nutritional guidelines people want to cut everything, they're cutting cutting cutting cutting cutting and they

start to have adverse effects from the diet, right from thinking excessively about food, access is very restricted, right, and it's sold as a lifestyle, so if we open social media, it's the lifestyle to People are also working out, they're on that super regimented diet, so it's seen as this place that we also want, right, and the great thing about this is that they're edited lives, we don't know what's happening behind, right, the suffering that edited lives is like that for us. doesn't know the suffering that is behind it, because the People who deal with eating

disorders, we see how much this public ends up suffering a lot with issues related to the body, there is a lot of aesthetic pressure in the comments, people are also very cruel in the comments, right ? so be careful with what you see on social media but I think it's interesting you talked about the cruel comments, people really are Oh there are comments but I think people are cruel I still believe it's a minority uhum uhum right I don't know if I'm optimistic but I think it fits the person blocks, removes, eliminates because like that,

there are people whose pleasure is to make others feel bad, yes, yes, so if the person starts to let that happen, they're not taking care of themselves, right? I think that part of personal self-care involves you taking toxic people, whether they are virtual or real, in your life, perfect, even when it comes to weight, for example, if it is a person who weighs a little more, they tend to receive more cruel comments, right, if it is a person who has a super thin body and is very sick person receives comments of praise, I have patients

who often her parameter of whether she is thin or not are the likes And people's comments so ah Felipe I received x likes so that means I'm not that thin when I was thin at that time I had I don't know how much and you see it is a standard of self-esteem does not depend on the approval of others, right? And this standard that we are actually living is what does this and this is perfect from what you said, Felipe, and if the person has gained a little weight, they will receive criticism, if they have

lost too much weight, no one thinks So, something isn't happening, but it's good for you, I'd like to find out what's happening to you, which I want for myself too, because it's already something that's in this world here, uhum, uhum, right? thin is synonymous with Ah, it's perfect, I also want to have a little bit of that. I need this suffering to lose weight, but the big problem with this thinness what is sold today is that you start to lose muscle mass and the loss of muscle mass, especially in the legs, is linked to the

onset of dementia at an earlier age, so the thing is much more comprehensive than people can assume, exactly, exactly, right? I said people, the person is losing weight But they are losing muscle mass But I'm unable to reach anyone's Instagram or social media Uhum And say anything Be negative, I refuse, I will never be an agent of depreciation or letting As a person with social responsibility, you have to have this Be careful, right? For Everything uhum and so the weight loss or the gaining weight, it can come with several things associated with it, right AC,

a soap opera that is showing this and people sometimes don't realize the subtlety that is trying to show there that it is a couple where he tortures her because she eats uhm right and how much you show that there in real life how much this happens the desperation of wanting to please the other leading to this pathology that it is becoming right At some times she is restricted in others moments she goes there for compulsion, right? when he's not around, then, uh, how much we who work with people with eating disorders , especially we see

how much the pillars that lead this person to this disorder are far beyond just eating or not eating, exactly. It's far beyond, far beyond there will be this basis of control, you know, it's very strong and then the body enters this game of control, you know, the control over each element, everything is very predictable, so I would even say Sometimes people think that eating disorders are something related to aesthetics, it's very more about control than aesthetics because the extremely slim body Many times this person is not necessarily aiming for beauty, they are aiming for control,

to feel better, to feel in control of that, to be able to have that control over those quantities or that specific weight and as if life were controllable, right? few things in life are under our control, very little happiness has to do with us accepting this and following the path knowing which things I will control, others I won't and I will adapt to have better reactions to what is not under my control, right, perfect, perfect. and not infrequently Sometimes People will need to be very careful when we think about social media because people can often

be inspired by someone's eating disorder without knowing it, so sometimes people say wow, I wish I had this life, eat like this, have this body, calm down, you You don't know what's happening on the other side, but you know that a very small percentage of influencers are beginning to say, I can't take it anymore, if I'm not okay, I'm not okay for me, I'm not okay to inspire anymore. No one has had this movement of sincerity, right? which I think is very cool as well. There was a time, well before the pandemic, I think around

2015 16, there was a time within the Fashion universe when models had to have an exact minimum weight, right? I think that exact returned to another standard somehow because there was this concern that started in Spain, if I'm not mistaken, it's Spain, France, right, you couldn't have less than a certain body mass index because otherwise you were at risk, right, and it's interesting because people are very very most people don't have knowledge or self-knowledge so anything influences it very easily, even more so you affect people's intimate desires perfect perfect I have a colleague who is

an advertiser and works with marketing advertising and one of the things he said that It was very important, he said it like this, the industry knows how much it can impact people because if they didn't know, they wouldn't invest millions in terms of advertising because that will change people's behavior, right, if we think the beauty industry is a big industry is a millionaire industry you know and that makes a lot of profit from this and people are not questioning themselves, people are losing identity, everyone is changing, having the same standard, right, everyone gets luxury products,

each one is different on the other and we are starting to become a sales product almost in China, right? Like you look at everyone, everyone is the same iG iG exactly So you said like this, we are CP in the evolution uhum uhum, right, we are evolving in this direction, right? This loss of identity will be one of the biggest weaknesses in relation to changing the image, understand identity, it will sustain these aspects of the image, positive image, negative image, So this loss of identity is very dangerous. So if everyone is becoming the same, you

lose individuality there. they will lose individuality a full plate for getting sick, not getting sick and being a marketing ploy, um, literally, I always say, marketing knows more about human behavior than the person themselves, I'm not against marketing, but for example, when I see an advertisement, I find it interesting, before it seduces me I say that he wants me to want me and if I say that he wants me to say interesting I liked Luz I liked that outfit I liked it but I don't allow myself to be manipulated as if I were a child

that you give a lollipop so when I see it like this oh now I understand what you want, then I'm going to see it Ah , I liked the script, I thought it was interesting, I thought it was silly, here I see it with a different eye, I trained myself a long time ago to see it differently because otherwise we lose the freedom to be completely who we are. if it is totally, you lose a lot of this freedom and this loss of freedom is happening more and more people are stuck on social media, they

are stuck on cell phones, they can no longer live without it, right, the pandemic itself was like a catalytic moment for this, very very very difficult for us post pandemic until then towards the end of the pandemic it started we realized that first there was a good deal of eating disorders and people had alcohol ingestion of alcohol barbarity, so much wine was never sold. Look at this because people started to sell wine . This we had a very big impact in relation to something that we hadn't seen yet, for example with the pandemic, people couldn't

go out anymore, they kept doing all the meetings and gatherings on screen, from then on, people started to get very more sensitive to one's own appearance So by looking specific parts of the face details that were not a nuisance and after this constant frequent exposure began to have an increase in the use of filters people afraid of leaving the pandemic and the other finding and increased weight and wanting to take advantage of the pandemic to lose weight things from the like, so the pandemic was like an explosion of eating disorders. It was something like that

that was never so open in such a strong way, you know, and today things have normalized, right ? you're talking about this missing thing identity or making peace with what you see in the mirror is very serious, it increases a lot, anxiety disorders, this increases a lot, depressive disorders and suicide, yes, yes, we have a suicide rate that is not falling, ahem, right, that's a lot. So, before the pandemic, it was already high, right, the World Health Organization had already dedicated the year 2016, if I'm not mistaken, to the fight against suicide. Afterwards, people aren't

even talking, I don't think we're going to tell you because the business, let's wait for the wave to subside, because I don't think it will go down unfortunately right, drug use has increased again, even This aspect of suicide, anorexia, the second leading cause of death is suicide, 20% of patients die by suicide, it's very serious, it's very serious, 20% 20% 20% anorex, there comes a point where you enter into a exact range of Delirium Delirium Psychosis so in Psychosis the intervention becomes increasingly difficult because the person is certain of what they are talking about and

for them to be able to take their own life it is a very high risk, exactly that I say anorexia is not for beginners No, it's not for specialist treatment from a multi , a multi team And besides, be very careful because they disguise it very well, like someone who is delusional, they also try to disguise it all the time, right? It's very serious, for example, there are patients who Are you afraid of drinking coconut water, eating corn, what do you say? There are patients who often eat a single meal a day from a small

dessert plate, you know, and if the family doesn't pay attention, they will have lunch, have lunch, have coffee, yes, at what time do I I didn't see it, but you were taking a shower while you were taking a shower ah ah daughter, you look different I think you've lost a little weight, no, you're always wearing sweatpants so you put on loose clothes to hide it, so the family needs to be very attentive and the family is a big ally, the treatment of anorexia when there is a family is a treatment when there is no family,

it is another treatment in adolescence So I would say that it is impossible to treat a teenager without the family there F really with us and they are great Allies in the past, they had a lot There's a lot of criticism regarding whether it involves or doesn't involve the family, right? The family suffered stigma for many years as if they were to blame for their children's eating disorder, right, today we know that family members are not to blame for their child 's eating disorder. children poem is to make it difficult o the exact good prognosis

or not or help can help help the child free exactly but they are not responsible for, you know, they are responsible for the treatment for helping in this journey and when we bring them close to the parents, they often arrive very afraid, you know, the parents like that. I'm very worried about what I do now or minimizing, sometimes I might minimize it, I remember a teacher, I think most people minimize it, they end up minimizing it, it's a teenager thing, it's a phase that will pass, I also had it, my sister had it, her father

had it, right? And it's fine today, married, three children, you know? even a little chubby, which is what patients dread hearing this exactly, right? I remember that in the beginning, when we did the training there, at the very beginning, I was very impressed, but how did this family say that, why did they say that, but she's the mother she shouldn't say that she's the father she shouldn't say that I remember a teacher who looked at me and said, Felipe, hey, they didn't have to know anything, you're the one being trained in eating disorders, so we

have to train them we have to train them because sometimes we start from the assumption that Ah, she's a mother, she should know, shouldn't she, a father, she should know, a layman understands, I think she should inform herself Um, and know uhum, right, and ask how I can help, help exactly that in everything right, ex, but don't feel guilty, no, because that 's the point when we bring the parents in, we take the blame away from the parents, they enter into treatment They leave the place of defending themselves because they are not guilty, they just

might be very responsible for a good prognosis for the release of this son knows and brings the family together a lot when everyone is together and there's something Felipe, I saw this like this during many years in the clinic when you manage to take the blame away from the family Uhum And the family becomes a collaborative family uhum even if the worst happens They have a clear conscience, right? Because even if we do everything right, it can be perfect, right? But it's different when you take a person who has lost someone dear. part but it

is different yes it is very different that they are with us because the journey can last 1 year 2 years 3 years a lifetime we don't know how long this journey will be, right and the idea is that they can be together on this journey because parents can get sick, right? I have many families that I notice as those who arrive are also sick, in terms of despair, they have already undergone several treatments, they are desperate, they think that nothing else will work And then the idea is to bring the family and help them not

to get sick because we will really need them on the journey and that thing giving up is not an option it is not an option giving up is not an option it is not an option for us because in the house they will be the ones who will conduct the treatment and when they are with us things really start to happen, you know, even with all the difficulties Even though I sometimes see PR parents, it is very difficult in the renutrition process, it was a son who never had any problems, a son who was very

polite always very accurate, Perfect Son, profile, you know, perfectionist, the perfect son has excellent grades, he has to take excellent grades, so for these parents to set limits on children who have always been in that Perfect Son's place, it's very painful for them, I have families who say it, but Felipe, my daughter has never had a problem. nothing and now when I sit at the table and she has to buy the meal she curses me That's not my daughter and it's not really because the eating disorder is very acute to the point that this adol

anyone who will try to take it away she's in that quest for perfection, that's going to be the exact enemy and they stay until the patient feels very bad about it because at that moment it's so desperate that they end up leaving them, right, and we even say that they are teenagers who come into this profile that are so good that even for getting sick, they are very good to the point of reaching a very high severity, you know, and we look at these This aspect, this change, this behavior there, much more obsessed with things

far beyond, sometimes, food, you know, with teenagers sometimes have a pathological study so e.g. losing weight is not simply losing weight, it is being malnourished, going on a diet, it is not simply going on a diet, the patient is starving, and studying is not simply studying, it is being the best, so they always go much further and within that beyond, they end up having unreal, unreal demands so I remember families talking, but Felipe, how am I going to set a limit for my daughter to study less if she is number one in everything, if her

photo is in high school, if in the Mathematics Olympiads the third year in a row she wins, how do I I will do this and This is the This is the great point of working with parents. If a teenager stops socializing, he stops having other interests and only lives studying in his room. Something is wrong in this story, for sure, right? by the groups that even you were commenting on this construction of identity, so we really noticed this functioning, this perfectionist profile, very very much and they are patients like this in adulthood, very good academically,

professionally, with a career like that, very perf, very good, very good, very good, so you can see this axis, this personality trait there that ends many Sometimes they don't use this to their advantage and when their body weight drops, their diet starts with conflicts, a lot of suffering, we had losses of great renowned people, that Karen Carpenters, the Carpenters, who are still songs that everyone plays Wow, what a beautiful thing she is He died at the height of his success, you know, in terms of that and he was the victim of a horrible toxic relationship,

you know, these people who restrict themselves so much and demand so much end up accepting people who charge absurdly, because then they think that I ca n't do it, I want to please so there is a very long line There's a difference between self-restriction and accepting that another Toxic restricts your life, exactly, ex-it's very tense, right, it's very much, and life goes on becoming imprisoned, right, they restrict life, that territory, right, to keep proving, proving, proving, and you lose. even This aspect of this humanization is almost as if it is very difficult to set limits,

right, to sleep, to rest, limits on others, limits on others, right, they always stay in this place of I can do it, I can do it, I can do it, I can do it, I can do it, more and exceeding the limits in everything, oh Bru show for us the book Oh come on we have a manual on psychotherapy eating disorders editors Felipe Rafael and ta ra e o ta o ta Cord uhum good this book he like the taque is excellent in the in Toque Toque eating disorders the ta is he is good in

everything Tak is my boss at the hospital he is the founder of the eating disorders program at USP this book It was born out of the idea of ​​us being able to bring together existing treatments in the field of eating disorders to make it more democratic for people to have access, right? clinicians may have access for people to know that there are different treatments because sometimes the patient is undergoing different possibilities of psychotherapy because sometimes the patient is undergoing a type of therapy and was not responsive they say oh none of it will work for

me treatment works, I've been to therapy, it doesn't solve it, calm down, there are different models of therapy, so here we've brought together all these treatments with various groups of eating disorders in Brazil, Rafael Canelli is the coordinator of the team of psychologists at the outpatient clinic, and he's the founder and general head of from the outpatient clinic Oh, and Felipe there and man manoli, right manoli, who is a very cool publisher within the biomedical area, it's very good, yes, they are super partners at the hospital, they are healthy, and there is this one in

the future, there will be one another one that concerns childhood and adolescence that we are organizing so that we can democratize people's knowledge for children and adolescents is that this is where the treatments for Tari will come in, which is avoidant restrictive eating disorder, right, and in the future we want to set up for general population also yes because there it is more for therapists psychologists to have an overview of more clinical things and the other will be for lay people even to have us when it is important for parents especially for parents a lot

of people do this eh This giving of knowledge because it is knowledge is revolutionary, right, without it, everything is very restricted, right? I even wanted one like that. Maybe a dream, a dream, a desire to put together a cool recovery story in the future. Sometimes there are many patients who arrive with such a high level of hopelessness and even though you're talking about bringing data, it's still almost as if you're not getting there in terms of touching the patient, I understand, and inspiring the patient, so stories of recovery It would be very good, so that's

why when we have artists talking about the journey have recovered or are there taking care of themselves for a long time difference public people, right, public people, it makes a lot of difference, we have a photo about it, we don't have it here, uhm uhum, in nea Taylor, right, yes, aasm, I got to talk to her mother, we even posted something together because it's very delicate, right? how much in Big Brother are the people who were outside the house and also in the house with very delicate comments in relation to Wow, the men, right, had

perverse men there, I thought the women were even more United because the men were cruel and fine men outside the standard, right? It's true that people who are well outside the standard can point fingers or point fingers, right? And that's the great care, so it's good that women came together inside the house, right? in relation to this because you see a man putting pressure on her in relation to having a specific aesthetic with a specific body, this is sickening, we have to be very careful, besides being a lack of education, it's a lack of empathy,

don't comment on anyone's body, right? Body is a very delicate thing, respect, they talk so much about respect respect This is respect I even remember a story from a colleague, from the hospital, she actually passed away. She studied eating disorders practically her whole life and she even published this story about her, she had an illness related to cancer and she didn't want people to know Uhum And she continued working, continued carrying out her activities and she began to be amazed at people's comments regarding her body, saying wow, how beautiful you look, oh my God, what

are you doing, you look so radiant, so beautiful and She said inside when she I was listening to this and she thought, it's not possible that people are so beautiful that people are seeing because I'm destroyed inside as the years go by, the months go by, I'm sorry, people kept saying that and the moment came when she couldn't take it anymore and she looked to people and said, look, I'm undergoing treatment for cancer, I'm not okay thinking that people would stop and people's response was, but at least you're losing weight, it's not surreal, I understand,

almost like, what treatment are you? You're doing it because I want to see if I use it to lose weight because there are people at this level of madness, right at this level of madness so that we can understand how much people lose their critical body, it's not commented on, we don't know what the person is going through on the other side, right, they're going through depression due to cancer or any other element, we do not comment on the body It's the minimum, right It's the minimum Bru Let's go to the pipinho reporter ah FIP

we arrived at a very special moment Okay, we have a community called the sustainable human being community Uhum And it is made up of people who like knowledge, you don't need to be a researcher They are people that I like, you know, and each time they have grown more and more and we have the habit of 15 days or so before they come here, we present their profile to them and they go there and watch, we ask them not to pass on follow you still only follow when the episode goes on air, right And then

they go there and ask questions about your content Okay, so we're going to start now and then the one who gives them a voice is our pipinho, let's go first, first What are the main signs that indicate the beginning of an eating disorder and when you seek help, the first signs that we will notice will be a change in eating behavior, the person eating less and less, just talking about diet days, this person losing interest in other areas of life, and no one sees this person anymore eating together with others hiding the body So ​​these

are the first signs What we realize in relation to eating disorders when we seek help is when that person realizes that now they only think excessively about it and that life is revolving around it, right? Of course, we actually ask the person to seek help a little before that. so if the person starts to realize that they are afraid of eating they feel guilty about eating when the person realizes that they can no longer go off the diet because if they go off the diet they will be very uncomfortable So these are already clues in

terms of seeking help even to avoid a complete eating disorder or when family members or loved ones who T love begin to feel that something is different, they realized that there is something different, especially in teenagers, look for this lack of dietary flexibility, right, this radicalism of always wanting to eat the same thing, this family suggests, let's go somewhere different Oh, there's no Irritability alters the mood or or opposes it, it won't happen, you know, if the family notices this this resistance, resistance already Do you only make this type of food, or do you want

to control, control everyone's food in everyone's house, put everyone in diet is exact but there are others anorexics who are very anorexics anorexics who start to cook for the family and the family is now better but they never eat exactly they do but they do but they don't eat that's a thing they never eat together ahem that 's the same way of control they are controlling what everyone else they are eating and when they are asked, they will often say, wow, but I ate all day while I was preparing the food and I was there

eating while I was doing it exactly, I was proving this, it is a clue that we also know that we never sit down to eat right, perfect next Bru, how does bulimia affect the physical and mental health of patients and what are the most common symptoms, is there bulimia, and the patient will have some changes, right, maybe more subtle changes, it will be a change in breath and a change in the color of the teeth your throat will be sore and inflamed. In what sense are you talking in terms of vomiting? Does the patient end

up vomiting perfect perfect vomiting because, for example, ketones are more common in anorexics, you know, who spend a long time without eating? of They keep vomiting so much they have these changes in their breath, sometimes it's more acidic, but it's more acidic, so it's different from the completely different sore throat, and the fingers, Rousseau's calluses, right, those little balls that the patient sometimes has, which are caused by friction. with the tooth ends up causing in terms of mental aspects they will be patients who will live around the compensation So if you ate something that you

think you shouldn't need to compensate if you ate something that outside of the diet you have to compensate then life revolves around this aspect of compensation So these are patients who have an urgency to go to the gym, an urgency to lose weight, but they need to have a kind of immediate attitude after eating, you know, most of the time, so in bulimia we notice a lot of this desperation and wanting to do something to solve that and then when they put themselves at risk and health problems begin, sometimes they even use physical activity, right,

in a very compensatory way Look, it's me, of course I can't say but I'm at the gym when I see someone arrive very quickly go to the treadmill [Music] guys, this person drank something or ate and came to make up for it because that way you don't feel like you're warming up, right? organized phallus Jesus must have been like that meaning, right? You said something interesting, everything is really about control, right? Mainly anorexia and bulimia and bulimia, all of them, right? commotion, they also try to have that control, they are always looking for that control,

that search for suffering because in life we ​​control so little, so exactly next Bru like the Psychological support can be effective in dealing with the feeling of guilt in patients with binge eating, this is interesting because for example, guilt will be a feeling that will appear every time the person thinks they have done something wrong that they shouldn't have done. guilt it consumes eating disorder patients a lot when we think about compulsion I think the first thing is eh first first element is this person can they understand that binge eating is a disorder right psychiatric

doctor needs help from there it starts to clean up It's a little bit of that person's fault for realizing that it's not that they She's being greedy, it's not that she's being hungry, it's not that she 's being starved, it's all judgment, she's not being any of that. This is a diagnosis. It really needs to be looked at, right? person person to be able to deal with these moments of the urgency of the compulsion when the compulsion when the urgency visits, right, what can this person do in terms of self-care to stay safe and not

go straight to the kitchen and try to recognize What is the feeling being able to take care of this feeling that it can involve guilt, right in the pre or post, so here in terms of intervening in the guilt specifically we are going to first clean up removing this Guilt from the person in terms of I'm greedy I'm hungry I have no control over anything in my life understanding that it's a diagnosis starting from there, being able to look at this guilt in a different way, bringing elements of compassion, right, this patient has a little

more compassion towards him and being able to learn skills to manage the urgency of compulsion, okay, so we would go along these lines that about monitoring therapy an ex vai psychotherapy having tools to be able to deal with this better n idea This is the exact next idea Bru how the concept of body neutrality can help in the treatment of eating disorders I think the concept of body neutrality is incredible, body neutrality would be the body returning to being the body, so understand the body it comes out of that place of overvaluation because even if

we look at both we look at the love and hatred of the body, it's very interesting because on both sides there will be an overvaluation of characteristics of the way that body is and that's why loves and on the other side Fear that's why he hates because of this overvaluation, then neutrality will try to remove this overvaluation and the body goes back to being a body, belly, being a belly, without any additional adjectives, body, it stays in this place in the body, even to make room in terms of life and in eating disorders, I think.

that when we start to treat the patient we are Aiming for neutrality it is not necessarily this patient he is jumping for joy in relation to his body the idea is not this patient he looks in the mirror and has fireworks and that's it he is the happiest person in the world and it's also not about the person being depressed in bed, you know what I'm saying, it's about the body, it's going back to its own space, the body is much more than the body, we're more of the coroo, but for that we're going to

need it work a lot on this concept of neutrality and this helps patients not to get stuck in overvaluation, right? And then when life starts to happen, that's when they start to open up to life, so the concept of body neutrality helps a lot when we think Well, it's cool because there will be patients who will say, Felipe, I can't love my body. So this won't be an objective, it's neutralizing because sometimes there will be great difficulty in relation to these aspects of love aimed at the body and it will be that you need to

love your body this much Ach has that loving our essence understand what I'm saying because it's trying to fix on something that is changeable the body He's changing the body of 15 not the body of 20 not the body of 30 and so on from 40 to 50 and so on he changes time everything and you can't have control over something that changes all the time perishable at the exact perfect time it won't be perfect we are perishable at the time and that's one of the rules of life welcome to humanity welcome to humanity, right

and I think so beautiful when I see, for example, Fernanda Montenegro, I think she is a beautiful person, I can see, Fernanda Montenegro's age, she surpassed all the limits of concepts restricted to the body, she is so beautifully, talented, worthy, that woman was beautiful at any stage of life because her essence is to be that monstrous actress who gives us gifts, so every time I look at Fen I think she is stunningly beautiful because the concept of beauty, at least for me, has to do with functionality, how much that person is exercising their talent by

donating this for other people, so, may God allow me to be perishable over time with that dignity, I think it's fantastic, fantastic, even perfect, which I think is the neutrality of the body and the appreciation of what we really are because it is all of that in all the bodies she's ever had , right ? Sometimes there will be a speech associated with health and when we see it has gone beyond the health aspects it is no longer about health it is about control so it starts sometimes it even starts with an innocent diet you

know And then there is the game of control when you see it is about eating less and less then when that control breaks any nutritional recommendation breaks the balance and it's just about control being able to eat less and less we need to address this and it causes dysfunction because the person lives for that and everything else that is expected of all of us so that we can develop our talents that we can share, it ends, it ends, you said it, I said it I just remembered a patient who sent me a meme of a

house on fire and a person lying on the street with a magnifying glass and there was a pea on the sidewalk and the person with a magnifying glass like that, how many calories are there in that pea and the house burning fire ago, she said Felipe This is my life, look, look at the representation, right, and you notice that everything is sometimes on chaotic fire, How many calories are in peas, right, so it's about exactly this question, when this control goes beyond the balance and we realize that the person is there obsessed trying to control

that excessively this is the time for us to be able to work it is of great importance Definitely right next Bru how family support can help in the recovery of a patient with eating disorders they are the best Allies they are the greatest Pillars they are the best Allies a strong Pillar because the family members who will be in the house and who will follow the treatment in the house, we will need to take care of these family members, have a lot of compassion for them and how they can help in the recovery, first by

having family meals, this is very important, being informed and being able to see with nutrition the aspects of how can you do the preparations, portioning, sitting at the table with your child , being patient? enemy in his little head, exactly, he sees them, the food comes and they are already activated, so the family will be a great partner in all of this so that we can have a lighter recovery or even with more love, right, more effective, more effective So family members can helping from beginning to end, having family meals, portioning, not commenting on the

body, avoiding dieting, right, it's not the time to go on a diet, it's not the time to talk about bodies at the table, commenting on so-and-so's body, so I'm the family I think it's a precious stone, yes, I'm sure treatment is the basis for everything there it is the base next Bru are there strategies that you recommend for patients who struggle with binge eating yes I think the first strategy is binge eating it is there to often solve a problem that is happening right so at times the person has had a fight with the boss

There has been an increase in emotion and is biased towards compulsion So the first thing we will have to understand What problems the compulsion is solving, right? Why is it going towards a resolution that does not solve but the person she has the what is often an escape from the problem or changes what you are feeling, there is a quick short-term pleasure, so the first element is for us to be able to look at what the compulsion is trying to solve in terms of problems and from there we look these problems, right, to take care

of these emotions, see if they are solvable problems, resolvable problems or if they are manageable problems or they are problems, you will need to accept it, even the word acceptance, so I would go there in terms of initial strategies so that we can organize a little, eh and the patient is not thrown into the air and down in relation to compulsion, perfect next Bru, how do socially imposed aesthetic standards affect the development of eating disorders, we talk well about this, they affect a lot because it enters into an aspect of vulnerability, right? I think the

media, every day, the person looking there one Specific body type , right in the advertisements on the billboards, which now don't have that much anymore, right, but on social media, every time, receiving this message about a specific body, the person will often feel inadequate if they don't have that body or if they're not close to that body. From then on we start to see some weaknesses if there is a genetic aspect if you already have that super rigid personality axis, all of this will be this combination in terms of the development of an eating disorder,

something that I have loved, it's cool, I don't know if you've noticed, there are more popular brands and that has been done a lot. advertisements, both on open TV and on networks, with completely different models PR, right, so many completely different choirs, so we have to applaud that too because otherwise we're just talking about what we don't do but there are people doing it, right? I think there are brands there What has I noticed This is mixing, right? Not only the issue of color, but the issue of body shapes, different ages, genders. So, it's cool

that it remains exactly what the treatment process is like for someone with an eating disorder and what are the main challenges that patients face during recovery, I think it's more about recovery because I'm okay, in terms of recovery, I think the biggest challenge will first involve the person being able to distinguish between the thoughts of the disease and what it is, right, because the disease will often speak a lot and sometimes the patient when he gets in this duality of wanting to improve but often the thoughts become very strong while they are improving And then

the patient believes that if I continue to improve it will get even worse but in the process he gets this feeling that the disease is very strong so The Big Challenge in the Recovery process is trusting the team , often trusting what is being said, different from the voice of the disease, having other voices there that can help you in this recovery process and starting to distrust the voice of the disease, right ? disease and this is the big challenge because the voice comes with a certainty that even you were commenting on, the more serious

it is, the more accurate it is, so much so that I have some patients that even I ask the voice it comes as if it were an obligation and that it is impossible not to do it or this voice comes as a rule that is very difficult not to do but it is possible to break some rules even if suffering comes soon after or is it a suggestion that this voice is giving you understand so the big challenge is to trust your team to put together a team uhum Sometimes you may realize that it will

be uncomfortable in some stages of the treatment but it will get a little worse and then get better and you will see how liberating it is, it is perfect now It's important to know where to look for help, you have to know Spanish because you can't help but be an exact specialized team, there's even some information because there are people, for example, who go to get endocrine medicine. There are wonderful endocrine specialists, but there are endocrine specialists who specialize in exact diets . with things that today are even prohibited. So we have to be very

careful, we had a piece of information that came out that was something that helped everyone to remain firm in specialized treatment, which was the result of this research, it was, uh, whatever. treatment and no treatment is better than any treatment for an eating disorder so patients who never had treatment within one had an evolution patients who were on any treatment had a smaller response than patients who were not on treatment because it is the search for that that knowledge Look, this is fundamental Because you only have knowledge You can even look for a doctor or

a psychologist but when you get there something doesn't match up because of what you studied because of what the person is fanning or else you question the doctor or psychologist and he will give you a uhum an answer and say like that I didn't understand anything I asked why the banana is yellow the person responds because the tangerine is Coral, you understand, so we are at a time when social networks have brought many things, including you having access to really important content, perfect, I said, it took me a while to find you, I stay, You

know how much I spend of social networks looking for possible people to interview This is my expense that sometimes I'm like this and then I start sending suggestions to the team and then they'll check an option for rules and we'll make a suggestion, okay, okay, I'm like this, no not because you in this Look Then the person is there like, oh, because there's tea with I don't know what, you're going to miss drinking tea if it's natural, how wonderful Drink the tea But this isn't to cure this or that, I myself have some tea here,

I have some tea ginger but I'm sure this doesn't cure ulcers, you know, it doesn't take away my hunger, but I like the tea and it's good, it's a way of hydrating, Bru What are the main risk factors that predispose a person to developing an eating disorder? the first element I think the first risk factor can involved is going on diets, so restrictive diets, these fad diets, we will have to be very careful because this could be the first trigger if the person already has a genetic aspect. You already come from a family that is

super concerned about weight, body, food, right? This person already has this more rigid personality, they have always been excessively demanding this pressure of control, this very strong issue of control, dieting without professional care can be a major risk factor. So the main risk factors will be dieting early, eh this person stays only consuming things related to aesthetic standards, you know, having a more rigid personality, families that have a lot of this ideal of beauty, focused on a thin body. So there are some risk factors that we perceive in this population and you said something now,

you said during that now I I remember, and in a little while you 're going to have to combine eating disorders with games, seizures due to games, we're having an epidemic and these people are in front of a Telo, they must eat a bad option because they can't get out of there exactly and that's what it is happening anyway, so we have to see next Bru charming now that it's the pipinho moment he also wants to know, right he likes it too he's heard a lot about you and now he's playing a joke on his

mother he His mother gives him the voice that we say it's a ping-pong, they are key words so she will play for you and whatever comes to your mind you say, okay, that thing hit it, it took it, come on, you need to look, he won't Talking still can't look at PR, we're here for us, okay, we want one day, we want Pipi to say that I believe, right ? humanity can be a sentence however you want, four if you could change something in the world what would you change Wow what would I change in

the world maybe create environments where people could feel more comfortable more respected more respected more comfortable I think that would be one of the ideals like a welcome capsules world welcome capsules good thoughts good energy wonderful I had never thought about it five life purpose my life purpose I think it involves teaching learning, right teaching learning and giving a voice I think for this entire population I think I will work with eating disorders for the rest of my life and I I think that's what I'm doing it here to give a voice to these people

expert six love love look I remember it immediately in my family like this I think I learned love from them I live through their love I think it's what fulfills me so I can deal with challenges a to do a large part of what I do seven complete the sentence self-care is self-care is a commitment in terms of limits I think that self-care goes a lot in this direction of us being able to respect ourselves if we welcome being with us, knowing how to ask for help, right knowing when to Oops, now I need to

collect myself, take care of myself, so self-care go in that direction uhum perfect eight resilience resilience meaning for me it would be resilience eh being able to deal with what I thought I couldn't deal with you know in terms of challenges sometimes it seems like the challenge is too big wow I won't be able to Ok come on let's try let's go with an open heart giving up is not an option giving up is not an option exactly perfect in the longing for the beach I think even here coming to Rio awakened this longing for

the beach I'm saying I grew up on the beach so I came here to Rio I saw the beach I said wow I miss São Paulo if not São Paulo is a little longer Far away, right, we don't see a beach there, so I got this nice longing and 10 a sentence or a thought could be yours, it could be a quote however you want, a sentence, a thought uh I was taken by surprise Let me think, okay, no problem, a sentence I I think people can have more self-compassion, I think I'm studying some things

about self-compassion, I see that we need very, very, very high doses of compassion, compassion, I would say that people might allow themselves to have compassion, to know what self-compassion is because today in my case, it's a fundamental stone, so you know, it's a foundation, self-compassion, everyone, right, for us to build ourselves, right, ex, and if we build ourselves, exactly, and be patient in the construction, then, self-compassion, cza will help a lot with this Constância and Constância, dear, I wanted to thank you, let's close here, thank you very much, it was a It's a pleasure to

welcome you, we now have a little gift here for you, it's an ecobag here from the pipinho that has our words written on the back, right, do it with inspiration, you can P I went here, we have a notebook for you to put all your notes on your projects that we don't believe in written language, okay? And here's a mug for you to drink this one stuck here this one stuck, wait, let's open it, here's a mug, here's a mug from People for you to take to my office Definitely PR you remember us, this is

here later the boys will put it Don't worry, a new book that will be released is around the 15th, the 20th, but it's already here for you, which is a while for me, thank you, which are based on phrases that I public are always 10 minutes of self-care divided by seasons of the year but you can start on any day these are phrases and reflections for us to stop and And think about ourselves a little Thank you, there is also the book Happiness that I wrote during the pandemic, great, there are depressive minds here, ok?

that many certainly end up walking for depression and there is here overcoming TDH which is an experience with neuro feedback from Alex which is a really cool work that we are also developing and you also have a book eating disorders have no mind he is out insatiable he is out I never stopped to It would really need updating, right? But it ended up getting in the way, it's a lot, it's a lot, it's a lot, and we also want you to stop, look at this camera, give all your messages, you can be polite, you don't

need to look at us, don't worry. Did you watch the podcast and Somehow you identified with something we talked about here in São Paulo we have an eating disorders program through the SUS which is ambulim, look on social media for Instagram which is ambulim or on the internet itself the website is www.ambulim.org .br the Brazilian center for updates and eating disorders for the general public who want to follow up on eating disorders has the Brazilian Association of eating disorders astral Okay, so follow all these people and also Follow me, mine would be Felipe and Augusto

without the O and on Instagram you tell me and Felipe with two L's Felipe with two exact L's and augusti this without the O without the oo dear we are finishing another episode of pod people And today it was with this super cool guy who I didn't know Felipe Augusto de Lima He specializes in eating disorders and we deserved to have his knowledge to be able to share it with you if you liked the episode share it share it with everyone who deserves this knowledge and also share it with those who urgently need this knowledge

because here in the community we can pipo us believes that knowledge and self-knowledge are revolutionary, no one changes without knowledge and self. Thank you very much, those who are not registered take advantage of subscribing, ok to receive all the news and thank you very much and see you in the next POD