Dr Andrew Greenland: 0:00

Welcome back to Voices in Health and Wellness. This is the show where we sit down with pioneers in health, functional medicine, and mental well-being to explore how care is evolving. I'm your host, Dr. Andrew Greenland, and today we're joined by Dr. Jeffrey DeSabo, an award-winning neuropsychiatrist, the medical director of ED180 treatment programmes in New York, and the author of the soon-to-be released translation, Demystifying the Neurobiology of Eating Disorders. Jeffrey brings a unique voice to the world of psychiatry, blending neuroscience, existential psychology, and preventative medicine to explore not just how people recover, but how they thrive. His book, The Neurobiology of a Bucket List, unpacks how purpose, meaning, and proactive life choices affect brain function, behavior and long-term well-being. Jeffrey, thank you so much for joining us today and welcome to the show.

Dr Jeffrey DeSarbo: 0:44

Thank you very much, Dr. Greenland.

Dr Andrew Greenland: 0:47

So if we can, perhaps we could begin a little bit with your background. How did you get started in psychiatry and what pulled you towards neurobiology and eating disorders specifically?

Dr Jeffrey DeSarbo: 0:57

Well, I I'm actually one of those people who took an unusual path into medicine, and that uh my original degree was in banking and finance, and I worked in the city. And after a few years, I felt uh I wasn't being fulfilled very much with my life. And I uh came home to my wife after a business trip and said, you know, I think I want to be a doctor. And she was a little like caught off guard by that because I never talked about it. Long story, I did apply to med school. I was married, I had two little kids, I found my way, uh initially wanting to go into pediatrics because I would go in with my kids to their doctors and have to wait too long. And I thought I could run this better than that. And in medical school, um, I did my rotations, and it really was when I hit my psychiatry rotation that I kind of remembered what I heard on my first day in medical school, which was if you love what you do for a living, you never have to work a day in your life. And doing that psychiatry rotation, up until that point, I had no real um strong direction or pull to go in that. I was at that point thinking of infectious disease. Uh, but my psychiatry wasn't like work, and I just loved do it and my interactions with people and everything. I so so I gravitated, did my psychiatry rotation. I did it on uh Long Island uh through the NYU program at North Shore uh Medical University Hospital. And during that, two of my advisors, when I was a resident, were pioneers in the field of eating disorder treatment. And so I think they were an influence on me at that time. Uh after graduation, I started working with patients. I just really developed this fascination with really trying to understand better uh the functioning of the brain in uh psychiatric conditions, especially with eating disorders, because uh one thing people may not always be aware of is uh people will always say, Why did I choose eating disorders? It's you go through medical school and you learn all this background in medicine. And the thing about an eating disorder is it really is half medical, half psychiatric. So it allowed me to kind of like uh um utilize all the knowledge that I had acquired through medical school and residency, but really learning about the brain was became something that once again it wasn't like work. I would read articles just non-constantly about how it affects our cognitive functioning, our emotional functioning. And it was just something that never stopped.

Dr Andrew Greenland: 3:35

So thank you. And that leads us nicely to the next question. Could you perhaps talk a little about um ED180? Uh, what's the philosophy behind it and how it's evolved over time?

Dr Jeffrey DeSarbo: 3:47

So ED180 um it is something I created um right after uh I started my private practice and I was seeing patients, and there's not a lot of experts in the field that truly understand an eating the nuances of the eating disorder and the language that goes with it. I always say it sounds English, but it it's not. There's a lot of tricky uh uh nuances to uh what someone says and what they mean and what they hear. Um so ED180 was something I I started in my office space having therapists working with me and having nutritionists working with me, and another psychiatrist who actually specializes in addiction was in my office. And I put together uh essentially an intensive outpatient program and also had a uh partial hospitalization program going with it. And the name ED180, I chose because uh we use the ED or we say ed. We will often refer to the ED voice in a person, it's not a schizophrenic voice, but it stands for eating disorder. And a lot of people think ED180 stood for the 180 is turning things around, and it does have that, but from a neurological point of view, um I've always learned how when you want to make significant changes that stick in life, it takes about 180 days for that wiring to really start to form and stick, and that's how I came up with ED180 and which became more of an organized um uh IOP and partial hospitalization program, which it ran pretty much uniformly as that up through COVID. Once COVID hit, things took a change. You know, now with ED180, we kind of put together customized programs for each individual depending on what their needs are.

Dr Andrew Greenland: 5:39

Thank you. So, what does it look like from a patient perspective? What's the patient journey on somebody who's embarking on this program?

Dr Jeffrey DeSarbo: 5:45

Well, it all depends where that patient is. Is it someone who's new? And if it is, then there is a lot of psychoeducation involved. Um, if if it's somebody who's been chronic with this disorder for years, then it's often us doing intakes and trying to find uh that unique individualized approach that hasn't been tried. I um there's been a lot going on, a lot of talk in my field right now of palliative care. And sometimes, well, we tried everything, maybe we need to give them kind of an end-of-life plan. And um, that's not a view I've ever had. I've always felt there's always something different. There's always something that hasn't been tried yet. So depending on where they're entering their program, you know, they'll meet with myself. Uh, you know, I always say if you want to look at what's a gold standard package, it's usually they have to have their physician, their nutritionist, their therapist, which is key to it. If they can have group therapy and as well, the psychiatrist may or may not be a part of that, but um, it often is. And so there we're working as a team to try to help an individual. It's a very uh labor-intensive process for one patient, and you're hoping that most people on that team really do have some specialized background and training and eating disorders.

Dr Andrew Greenland: 7:03

So thank you. And moving on to your um book, um what inspired you to write the neurobiology of a bucket list? And how does that concept play out in clinical or preventative settings?

Dr Jeffrey DeSarbo: 7:17

Well, I do it it was something that I was heavily influenced, I have to say, by my father, uh who was uh a blue-collar worker. I grew up in a blue-collar lifestyle. He was a printer for the state of New York, and he developed uh renal cell carcinoma, kidney cancer, and he lived with it for 17 years. He had retired at that point um to kind of just uh take care because he didn't know how much time he would have left. And during those 17 years, I always let people know he he lived more in those 17 years of life than I think he did when he was without the diagnosis and living. And he said to me one day when I was looking to buy uh a house, he goes, he said, Don't put all your money in a house. He goes, There's a lot of things to see in this world, and it really stuck with me. And and that's when I actually first got my passport. I I've only had that passport for now maybe 12, 13 years, you know. But what he said and the stories he would tell me had me doing as much as I can with my time remaining. Um, of course, my interest in neuroscience was always a part of all of these types of experiences, whether it's travel, trying new things, and everything. And my father had passed away about uh six years ago, seven years ago. And I realized how it all kind of came full circle and it tied in. And when I studied the brain with the things we do with a bucket list, it has this kind of like you said, preventative anti-aging effect, you know. Um, it works so well in conjunction with other things people do um to to improve their life as we age, you know, with exercise, eating well. Um, but the uh the studies that I kept coming across and reading um about goal setting, about intentional living, it showed how our brains still remain plastic, you know, we're forming new neurons, new connections. Uh, we were how do we keep our own body's production of things like dopamine and serotonin elevated? Because once we reach 40, they start declining by 10% per decade. And but living with this novelty and new experience helps keep the brain's natural ability to produce these types of neurotransmitters elevated. So it's like I said, you can take care of yourself, but you still have to live a life that's kind of active and novel and challenging. And when we meet people, we can see that. When we meet somebody and they tell what how they're living their life, we almost sense there's more of a vibrant energy within them. So, you know, that that to this day, I have to tell you, that's been the biggest thing. And I, you know, I'll do the most crazy things that I don't even, you know, you know, I always say like this earlier this year, I took acting lessons. I have no desire to be an actor, but I enjoyed it so much. I could feel it working in parts of my brain that I've never turned on before. And it had social context, so my oxytocin was working well and everything. Um, and those are the types of things I I discuss in the book because it isn't just about making a list and checking things off you want to do. You know, it it's it's really living kind of the semi-structured bucket list style approach, takes all the principles of neuroscience of novelty and it puts them into action. So we're always learning, and and it's been something now that I I I see through even the people I've worked with, sometimes in my own office, will discuss their bucket list plans, how to go about it. They have my most of my patients pick up my book, and and and I even developed an eating disorder supplement based on the main book, which um I did want to share. I'm proud, it it's felt great. I've given away now over 1,400 free PDF copies of that supplement book, which is on Amazon, but I have a category called legacy. Okay, it's like or or giving back in life. And for me, that's something that I did during the Thanksgiving season this year. And it's, I'm telling you, it's been overwhelming. Uh the feedback, the appreciation, you know, it's both boosted my dopamine and serotonin. I want to even do more of it now. You know, that book that you mentioned, the neurobiology of eating disorders, I have coming out, that that that's a that's the type of book that goes for close to $200 on Amazon because it's almost like a textbook. But I'm already sitting there thinking, ah, for people in my profession, if they want a free PDF copy, I write, you know, I'll give it to them, you know. Um, so if anyone does see that when that book comes out, I always tell people, just send me an email, I'll send you a PDF copy. I'm not an author, you know. That's a that I have my daytime job, you know.

Dr Andrew Greenland: 12:16

Okay, well, very happy to promote it on the podcast page if that's helpful. Um don't you get overwhelmed, but I'm very happy to do that for you and if that's helpful. Um, so there's an awful lot of talk about preventative medicine, um, but I think you've referenced preventative psychiatry and the conversations we've just been having and some of what you're writing in the books kind of comes to that. So, what are you seeing that makes this more relevant today? What shifts are you seeing that make preventative psychiatry more relevant and more important?

Dr Jeffrey DeSarbo: 12:43

Well, it it's almost that there's been uh, you know, I I could say since COVID especially, but I think we can go back before that in the sense that uh uh we're getting blasted in the media with the type of information and the manner in which it's presented. Um because my initial degree was in um um banking finance, and I and my first job was with marketing and marketing research. The one thing that I re recall all the way back then is like the two human emotions and drives that in a market-driven economy um media wants to create in an individual is fear, anger, you know, anxiety and anger. And that's what keeps people tuned in to social media, to news uh stations, to to newspapers, okay? And that's what sells advertising. But we've become very good, and now with AI, of learning how to induce those emotions in people. And it's done on such a seductive, uh, unconscious level that we see a lot of intolerance, a lot of anger. So now, more than ever, taking a proactive approach and preventative health, especially with our minds, is is so important. Um, you know, it's it's it's it's it's it's it's interesting too, because like even in therapy, I think people are becoming overwhelmed. They pull away from therapy a little bit. Now's the time to go into it, to stay on top of it. You know, I always say a good therapist is you know somebody who helps keep you thinking in top form. You know, I always will say to people, when Serena Williams was number one, she still had a tennis coach. When Tiger Woods was number one, he had a golf coach. When you know, all these people at the top of their game still have coaches. They're not better than the players, but they have somebody there to keep them kind of like on track. And to me, um, even therapy is very preventative when you have that connection with a therapist who helps you thinking and functioning in your peak performance zone. So thank you.

Dr Andrew Greenland: 14:57

Um so is there a growing openness amongst patients and clinicians towards um more lifestyle-driven brain health? I guess by the response to your PDF promotion of your book, you'd probably say yes. But so more outside of that and in the wider world, what would you say about um the openness to this?

Dr Jeffrey DeSarbo: 15:13

Openness, again, clarify for me.

Dr Andrew Greenland: 15:15

You mean like how how patient towards lifestyle-driven brain health? Because it's not banded around this and it's not a term I've heard very frequently, but you're really making um an important emphasizing the importance of it. And I just wondered whether it's something which is catching on and people are kind of um getting into well, I I I think it's something that's catching on almost more than ever.

Dr Jeffrey DeSarbo: 15:38

Um, the question is like uh, you know, it's like I'm somebody who always believes with with mindfulness approaches, we have to learn how we live in a gray area. So I think since COVID, there there might be something going on with younger generations where not only is it catching on, it's all about lifestyle. It's like, no, I don't want to go to work, I just want to work from home and I only want to work 20 hours a week and I want to play, you know. Uh for other people, there might be a fear that's going on. Their anxiety prevents them from trying to find that balance in their life. So I think the key is how do people find kind of a balance between um living a lifestyle where they still are productive and they, you know, can take care of themselves responsibility, but not to the point where they're so stressed with what they're doing that it's reducing their own productivity, not just with work and but with productivity with family, with productivity with balancing their stuff so they have time to exercise and do other things that are healthy with their lives. And then, of course, ever since COVID, my concern and worry has been uh increased use of self-medicating with things like alcohol, uh, THC, and other substances. So when you use the word lifestyle, that is the word to try to figure out for longevity and happiness and feeling a sense of purpose through balance with doing things uh with like kind of a bucket list approach, as well as still finding ways to uh get done what we need to do in this world.

Dr Andrew Greenland: 17:21

So thank you.

Dr Jeffrey DeSarbo: 17:23

I hope that answered your question. It does.

Dr Andrew Greenland: 17:25

Thank you very much. Um I I I I remember you've got you've got an upcoming talk to the New York State of Um State Society physicians. Right. Um if so, what are you hoping that your peers are going to take away, especially those who might be nearing burnout themselves?

Dr Jeffrey DeSarbo: 17:38

Yeah, that's actually one of the um learning objectives that we always have to say. It's like, how do you prevent burnout, especially in in with physicians in healthcare? And I when I found out that they were doing this and they reached out to me, I I didn't even know that they're New York State has a speci a special uh initiative program that they've been doing on physician wellness, which I think is very good. And and and and so when I work with them, it is talking to them about thinking about themselves and implementing a plan that helps them again find that balance between their life and the demands, especially uh with the things that have been going on in healthcare. And uh, as I'm sure you're aware, in the US, there's been some changes in the way people think about healthcare. You know, uh there was a uh an announcement about a post on a CDC website. My friend who's a psychiatrist in Arizona reached out and just sent me this text and said, okay, that's it. Medicine is a medicine and science is officially over in the US, you know. So so hopefully, you know, I can I can talk to the, I'm gonna use the outline of what the concepts of a bucket list is, because again, it's not about just picking things you want to do and travel or skydiving. You know, I always use it, there's an anachronym that I that is what I think a bucket list is all about that helps with physician wellness, anyone's wellness. It's called IPIG, and not iPod, but iPIG, which means it's intrinsic, means it's it's living a life that is something that means something to you. The P is it has that purpose to you. Um, the other I is that it's intentional, meaning it's not things that are just happening to you in life and you're reacting to them. They're intentional decisions on a bucket list that you make for yourself. And the G is it it fosters more gratitude, and and that's what a bucket list is. It's not again the whether that's through travel or skydiving or going for walks around the block or appreciating sunsets and painting and photography, that's the uh intrinsic component for each individual. And you know, I I I think when it might seem obvious, but when we're living in a a word that a world that's kind of becoming more and more chaotic, it's so easy to forget the obvious.

Dr Andrew Greenland: 19:57

So thank you. You've um referenced COVID a few times in the discussion. Um, how has your own thinking shifted since COVID in terms of what patients and clinicians really need?

Dr Jeffrey DeSarbo: 20:08

Well, that that's another component that uh um it's it really did shift a lot, uh even in my profession. So much now has become telehealth. And uh there's a study out. I I recently wrote an article that was in Psychiatric Times about uh the article was titled It Beyond Convenience, and that medicine, you know, it's like people just in especially in therapy, psychotherapy, and everything, uh it's just easier to do it virtually. But I I talk about how we have to proceed with caution, uh, especially when I work with difficult cases of eating disorders, or there may be difficult cases in substance use and things like that. Um, the office visit, I feel, still gives us so much more information than virtual. But virtual has also opened up therapy and treatment to a lot of people who otherwise wouldn't have had it or wouldn't have invested the time. But uh I I think we're in a period where um we have to, there's gonna have to be research in the true um studies to say how effective is it? Um, because most of them right now seem to be saying, oh, it's it's almost equally effective, but then I look at who did the research, you know, and it's often covering from centers and stuff that are doing it virtually. Um the other thing was what happened with COVID um is self-medicating seems to have skyrocketed. Um uh alcohol use disorders are way up. Um there seems to be also so much more anxiety and uh and even rates of specifically of like obsessive-compulsive disorders, illness anxieties that have skyrocketed in my clinical practice, almost doubled. Okay. So fear, anxiety, I think COVID really shook us up in the world, you know, and and and it and it led to further division in our society with people and who should be vaccinated, why you shouldn't get vaccinated. You know, all these things that that that that this has done, not to mention what it did to the youth and taking them out of schools and and and and the effect that's had both socially and academically on them. So there's a lot more anxiety that's popped it, popped up since COVID.

Dr Andrew Greenland: 22:33

So thank you. And obviously, um that your practice and the platform and the programs are all businesses in a sense. Um, looking at them as businesses, what's working particularly well for you and your team? What are your kind of success stories, the things you're proud of in the way that these things um kind of panel?

Dr Jeffrey DeSarbo: 22:48

Looking at what business?

Dr Andrew Greenland: 22:50

Um, from the point of view of your practice and the programs that you run, they are essentially businesses at the end of the day as well. I'm just curious to know what your what's going particularly well, what's working for you in this space.

Dr Jeffrey DeSarbo: 23:01

Um, I think what's always worked for well in this space is um the therapists and the nutritionists that I have in my office, because I'm there and it's a we're we're we've always been a close-knit group. Um, all of my therapists and nutritionists do have a strong foundation in the neuroscience of treating eating disorders and the brain expectations. We we're able to talk to patients about this in terms that they can understand and relate to, uh, so so that they know that it's not just that, you know, it's a character flaw, or all you have to do is just eat more. And you know, like everyone in in my office has an understanding of what drives the process. I also think the people that I work with, um, we all have the same type of um uh personality, you know, we're we're relatable, we talk to people, which is so important in this field because um one of the main factors, you know, when a person says, I feel fat, and they have anorexia nervosa, the anachronym we use to that is that they have fear, anger, and trust issues. So having that ability to talk, communicate with the people we work with, it's a process that we have to earn their trust and understand their fears and their anger and anxiety with everything. So I do think that from from my um own perspective that first and foremost, it's the people you work with in this field. Um there has been a trend um where uh if if we go back like two decades, uh pretty much every treatment center was privately owned and run. Um people would make hiring decisions on staff based on experience. There's been a little concern now that the venture capital firms have come in and pretty much bought almost all of these um eating disorder centers and it shifted from a little bit more from patient care to profitability for their for their investors. And so sometimes I I certain certain places, not every place, but certain places, the caliber of people working in treatment has suffered. Um, but the one thing I think, like, you know, I've never been in that realm. I I've always had been able to work with the people and bring into my office the people that I want to work with, and I think that's one of the keys.

Dr Andrew Greenland: 25:33

So yeah, you can't can't overemphasize the importance of a good team. Um on the other side of the coin, um, what are some of the challenges in doing this kind of work or bottlenecks or things that you really struggle with in the business?

Dr Jeffrey DeSarbo: 25:48

Uh well, I think because we are so dedicated, maybe at times, you know, we do feel a sense of more responsibility. You know, it's not less like we're seeing a patient, okay, I'll see you next week. Uh and and you know, it takes a lot of practice. We have to uh have our own training, and how do we deal with this so we can go home at night and not be able to sleep over some cases because eating disorder cases uh still are one of the highest mortalities in anything in psychiatry. Um and so there's a complexity to the treatment. Like I was saying with the team, is it's a it's important you have a good team, but you have to collaborate. It's not like if I was treating just anxiety or depression, someone can come in, I can talk to them, maybe prescribe something. Um, it's like I have to be in touch with the therapist, the nutritionist, the doctors. So it's that's what I say, it's a much more labor-intensive process, you know. And sometimes when we have multiple patients who are struggling, it can be a little bit overwhelming. Uh, and that's the day sometimes I think, well, maybe I should just specialize in ADHD, you know, and they can come in, I can give them a med, and it works. But uh, but I know it's it's my dedication to the field is something that I feel strongly about. And and again, because I've worked with others, um it it's made the effort and the difficulty at times much more tolerable because we also share in that uh empathetic outlook we have in caring for our patients.

Dr Andrew Greenland: 27:31

So thank you. And what do you do to look after your team, given everything you've just said about you know the risk of taking stuff home, sleeping on it, burning out? How do you support your team specifically?

Dr Jeffrey DeSarbo: 27:45

Well, I know at times I'm kind of in a a little bit of a leadership role. And uh I I my my personality, people who know me on the outside, uh, and and even my patients know, I try to teach, like, well, with everything that's going on, you have to not take life seriously all the time, you know. You have to be able to, again, keep that balance in life with doing things. So my I I think what I try to do is I try to set an example, you know, of hard work balanced with the uh uh myself living that bucketless lifestyle. But also not I I don't panic, you know, under some of these situations. And the thing about having someone new come in and learn this, you know, how do you treat a patient with a severe eating disorder is if you don't, you just don't panic, you know, because I see that in my field all the time outside of you know my office and everything. Um and if you panic, then the patient picks up on that right away. So I I think it's just I I try to lead a balanced life, a balanced approach, not take life too seriously, except everyone knows how seriously I am about the treatment itself, you know. But uh so I think lead by example is my approach to trying to help the people I work with. I I hope it's worked through the years.

Dr Andrew Greenland: 29:10

So I sure has. Um if you had a magic wand and you could solve one persistent challenge in your practice, your speciality, your field, what would that be?

Dr Jeffrey DeSarbo: 29:34

Well, it's interesting. I think it's access to treatment and and I think it's also um we're we're learning more. And when I talk about the neuroscience, you know, I I I really want all clinicians to understand that aspect. You know, uh a psychotherapist may not have a specifically strong background in neuroscience, but a lot of the stuff I try to put out there for people, including, like I said, say just tell people here's this book, if you want it, just take it, read it, you know, like like I think my magic wand would be in the in the form of educating people um in what we know, because we know in my view, some of the stuff I talk about or write about is uh 10 levels above where we were 10 years ago. But sometimes I think people are too busy in their own lives, that the continuing education component of treatment and being a clinician has fallen, it's suffered, you know. And so, so yeah, my magic wand would be people continue to take a strong interest, educate themselves so that they can then apply that to treatment plans and working with people.

Dr Andrew Greenland: 30:48

Thank you. Good answer. Um obviously you are running a business, you're clinical as well. What's the biggest time drain for you in in the work that you do? Obviously, there are things that you're passionate about and you love to do, but I'm sure there are things that are um less palatable, should we say? What would those things be?

Dr Jeffrey DeSarbo: 31:05

Well, it's funny when you say it because yeah, it is. It's it's the time management of everything. So the the time drain. And I feel at times there's so much I have to learn and remember that I, you know, couple that with my own ADHD. It doesn't make it easy, you know. But I have to stay on top of multiple cases and what's going on or what may be getting off track. You know, I have an incredible um office manager uh who's been with me now for close to two decades. And and you know, she's she's really a key part of what I do. Her name is Tamara, you know, and and she's from Australia, and she came here and she met somebody that she wanted to marry, she needed a job, and she was the perfect person. And what's so interesting is just by working with me, the education, like she can talk and handle my patients for me uh on some issues that aren't you know medically related. But but the time drain comes with the multitasking because again, it's not having uh a patient with depression, a patient with anxiety that I just work with with my end. It's this multiple patients, each patient with a unique presentation of their eating disorder and the need for collaboration and and and multiple you know issues going on. And as a doc, uh, as a as a as a psychiatrist that works with eating disorders, again, I do I probably order more lab results. I interpret lab results. I have to tell patients when you go to your medical doctor, I need you to ask them about this. I need, you know, at the same time, um, as physicians, we learn, right? Like physicians hate other people telling them, you know, what to do. So I'm delicate with that, you know. But then again, there's some physicians that are great that say, okay, yeah, I need another DEXA scan. And okay, no problem. You know, they they they actually appreciate um if they don't have that specialty in it, that that additional collaboration and input that I can offer without again walking that fine line of not being a pushy person, you know.

Dr Andrew Greenland: 33:13

So thank you. Um, I guess there's no shortage of work in the eating disorders field, but if you had a sudden surge of inquiries next week, what part of the system would bottleneck first? Hopefully, not you.

Dr Jeffrey DeSarbo: 33:27

Uh the part of the system here that really bottles necks the system is um accessibility, finding people who are qualified, and affordability. Um, our insurance companies here do not want to pay for eating disorder treatment. They they're not specialists who do the assessment as for coverage for the most part. Uh when I've needed to get extended days in a hospital or something for a patient, I the person I'm talking to, I feel they don't understand this at all. You know, that and you know, it it's there's been a recent change that I hope is going to take effect, but they'll just look at like with anorexia, what's a person's weight and BMI? So, well, then they can be discharged without any other safety concerns or anything. Um, they really don't understand nuances of severe binge eating disorder or believia, nervosa. So the system is far from just even being adequate, you know, and it's it's insurance driven, but it's not being driven in a form that I feel, you know, it's again about profits, it's not about a patient's well-being and bottom line. And I and I get it, I get I understand there's an economic component to it, but there are so many people with eating disorders that have subpar treatment that it's simply because of affordability. And then accessibility. Once again, I think the thing with accessibility is with virtual now, you yeah, okay, you can have access, you know, if you're in the middle of the country with no specialists, that you can still virtually connect with people. But uh even that it can be expensive because it's not like somebody just needs a psychiatrist or just needs a therapist. Don't forget, they need that team. And if they can't get coverage on it, it can be extraordinarily expensive. And I would often do talks, and patients and family would come up to me and say, We this is look, we have Medicare, we have Medicaid, we can't find the right treatment. Do you have what recommendations do you have? And I'm almost like empty with an answer, you know. Um, there are some nonprofit groups that try to help people, but they cannot cover um the amount of people that need further assistance, and and uh I'm a little worried where the future's going with that.

Dr Andrew Greenland: 35:53

So yeah, no, I hear you. Um if you were starting ED180 again from scratch, um, would you do anything differently from you know based on your learning and the journey you've had so far?

Dr Jeffrey DeSarbo: 36:08

There's nothing that pops right to my head, you know. I think I tried to do it, you know, the best way. I think there is a a format to it, you know. Um and I've always had the right people. Um the biggest thing with ED180 goes back to the same thing too, is um how do you form a program that you can make affordable if somebody can't get it covered? And usually, like I said, they don't want to cover it. It's like when I ED180, 180 days to make changes that last in the neurosystem, you know. How do you get somebody to cover 180 days of treatment? You know, it's it's it's difficult if somebody lacks the funds, and it's difficult to get any insurance company to do it, you know, and they'll then they'll find their well, okay, we have a couple centers we can recommend, and they're not always the best centers, you know. So the you know, I I guess I'd hit the lottery and then I would fund it myself if I could. That would be my change.

Dr Andrew Greenland: 37:16

So and what's next over the next uh six to twelve months? Are you looking to expand the clinic, publish more work, or reach more broader audiences for education, all of the above or none of the above?

Dr Jeffrey DeSarbo: 37:28

I I would say I have um, you know, in within my own bucket list, um, writing has been both a mindfulness exercise for me that I enjoy a lot. You know, I I uh with with the book and the eating sort of supplement book as well, um it's I consider that my contribution to education as well. I want people to learn about their brains. I want people to learn that there are things you can do in your life where you they're they're intentional, they're proactive ways to help recover. I've learned how incorporating this intrinsic approach, you know, I always say in eating disorder treatment, there are things that push people through towards recovery. That's your clinical team, your treatment plans, your nutritional plan, your medications, your thing. And then there's supposed to be things that help pull you through. And that's what's the existential kind of reason for you to go through all this treatment that's very difficult. That's where I felt my bucket list plays a role, is it gives somebody an extrinsic reason that helps pull them towards recovery. So I've been on that process. I've been writing in general, because I I think this is in today's world, this approach is such an important, needed way to try to think to counterbalance all the stress and chaos in the world. And you know, I created this website, bucketlistdoctor.com. I don't know if you had a chance to see it, but if you go there, I I it it's a fairly new website, and I must have 20-something articles that talk about that bucket listing mentality, how it affects the brain, it's got the emotional components to it. I talk about why I've written the book of the eating disorder supplement. So I think I'm in this phase of wanting to provide education. And like I mentioned before, I want to give back to my profession. You know, I've it's been a rewarding profession to me personally, intellectually. I, you know, they always say it's nice to make a difference in the world. I think that's why we do this a lot. We try to help people. And I always tell someone, you don't have to help the world. You know, sometimes just helping one person uh really means you contributed. And and so I like that I'm hopefully have helped one, maybe a few more. And I want to continue to help not just people who suffer, but I'm I think with my education, I'm trying to help people who are trying to help people. Who suffer, you know? So kind of multiplying that ability to maybe leave my mark in that way. So amazing.

Dr Andrew Greenland: 40:09

Jeffrey, on that note, thank you so much. This has been such a rich and honest conversation. You've got a really compelling lens, not just clinically, but philosoph philosophically. And I'd really like to thank you for sharing your time and your brain with us today. So thank you very much.

Dr Jeffrey DeSarbo: 40:22

Thank you.