The Fat Doctor Podcast

More Than Just Carrots with Dr Molly Moffat

• Dr Asher Larmie • Season 5 • Episode 12

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 In this episode, Dr. Asher Larmie speaks with fellow weight inclusive GP Dr. Molly Moffat about creating safe feeding environments for neurodivergent children that goes beyond conventional nutrition rules. They explore how diet culture and neurotypical expectations harm autistic individuals, while sharing personal stories of parenting neurodivergent children and navigating healthcare as autistic doctors themselves. Dr. Moffat offers transformative insights on helping children develop healthy relationships with food by prioritizing emotional safety over nutritional perfectionism. 

Molly works as an NHS GP and Doctor in Community Paediatrics, as well as a workshop facilitator for the social enterprise Body Happy Org.  She is both neurodivergent herself and a parent to neurodivergent children. Molly offers support to families whose children experience feeding differences, and to adults who want to improve their relationship with food. She practices through a neurodiversity-affirming, weight inclusive lens celebrating both diversity of bodies and diversity of minds. 

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Asher Larmie: Hi everyone and welcome to the Fat Doctor Podcast. This is episode 12, season 5. And we are very fortunate today to be joined by a good friend of mine. I've got a friend. See? I do have some. A good friend of mine, Molly, who is another GP. She's another doctor, and she's a weight inclusive doctor, and I know this is a very rare find, so very excited to have her here rather than doing that very awkward thing where I introduce her. I'm going to invite her to introduce herself. So, without further ado, Molly, tell us about yourself.

Molly Moffat: Thank you. Great to be here. So yes, I'm Molly. My pronouns are she/her. I'm a perpetually exhausted and overwhelmed human being, an autistic ADHD, a mum of 3, 2 of whom are neurodivergent. And, as you said, I work as a GP. So I mostly work in community paediatrics, and I'm a workshop facilitator for body happy org, and I have my own business supporting families and carers of children with feeding differences, and I do my best to practice in a weight inclusive neurodiversity affirming way through the lens of health and social justice.

Asher Larmie: And you really do and like, you know, it's very rare that I meet people who are very much aligned with me kind of in many areas, so often I can find something in common with someone. But to have so many things in common, it's quite extraordinary. So I'm very lucky to have you in my life.

Molly Moffat: Thank you.

Asher Larmie: And I think it's really important that you mentioned these things. I practice from a weight inclusive perspective and also a neurodiversity affirming, tell me how you got into that. What sort of made you realize that this was a good way to practice medicine?

Molly Moffat: Gosh! I wish this was a more kind of linear story, but it's very higgledy piggledy, and quite convoluted. I mean, I suppose throughout my career, and even kind of as a medical student I have always felt a bit of a pariah particularly in kind of medical circles, and I've always been very aware of the dynamic between doctor and patient. And you know, as a medical student, I can remember being quite upset by some of those interactions. And the way there's this kind of culture of not really believing patients or kind of invalidating their experiences. And you know, sometimes silencing.

You know I was thinking about this before we recorded, and I remember as a junior doctor on medical on call, treating this young guy who came in with viral meningitis. He was complaining of a really bad headache, so I prescribed him some medication, and gave it to the nurse to give to him, and she kind of scoffed and looked at me, and said, "Oh, oh, Molly, one day one day, you'll learn." The implication being that I was this kind of softy, and you know, for goodness sake, he wasn't in that much pain.

So yeah, I've always had this sense of slight discomfort with those—well, not slight, extreme discomfort with those kind of conversations. It hasn't felt right with me. And you know, that doctor, patient relationship, that healthcare, professional, patient relationship can be harmful, and I think that's kind of led me to where I am now. That sense of that power dynamic which I now have the language for which I never used to have the language for.

I was working as a GP and feeling a bit, I suppose disillusioned, wasn't really enjoying. It wasn't feeling very fulfilled, and was kind of desperately trying to find a way that did fulfill me. I discovered lifestyle medicine and had a dalliance with that for a few years, and went down some serious rabbit holes. I thought, like I really felt like it was what I was looking for. I felt like it was gonna allow me to practice from a more kind of holistic perspective.

Asher Larmie: No.

Molly Moffat: And you know I hate to say it. But it was this whole idea of kind of prevention better than cure.

Asher Larmie: Yes.

Molly Moffat: But at the same time, you know, I was also kind of recognizing my own neurodivergence, my children's neurodivergence, learning more about autism, learning more about learning disabilities and understanding health inequality, health inequities. And seeing how people are treated when they seek healthcare really impacts their health.

And learning about autism obviously, then, led me to learning about eating disorders. So on the one hand, I was there kind of learning about eating disorders, and how consuming and life threatening they can be. On the other hand, I'm in this lifestyle medicine space, where we're kind of arguing over the minutiae of, you know, a plant based diet versus a Ketogenic diet. And what is missing from this conversation, guys, is how are people feeling around food. How stressed are these people around food? What impact are we having on somebody's relationship with food and stress levels when we're basically creating fear over an entire food group.

And I actually was so—I was. I read the kind of obesity code and the diabetes code. And yeah, this was in the kind of Ketogenic diet phase of my rabbit holing and you know, I remember sitting with my children, and they were eating like white pasta and I was feeling really stressed about the fact they were eating white pasta, and luckily have the insight to go, that's that's not right, you know.

Asher Larmie: Right.

Molly Moffat: I don't want my kids to pick up on that stress. I want them to be able to enjoy pasta.

The flip side of this is that as a parent, I was always very aware of the language I was using around food, the language I was using in terms of my body around my children. And so I was kind of listening to—I was in the space of body acceptance and intuitive eating.

And I'd love to remember how actually, I heard about fat liberation and the anti diet space. But it must have been some podcast that I listened to around kind of intuitive eating in children and body diversity, and that led me to, I think it was the Christy Harrison podcast. And then I read her book. And then, I was on maternity leave at the time. So of course, I was kind of trapped on the sofa breastfeeding for hours. And so that was like the perfect opportunity to seriously like, delve into this special interest. And I couldn't—I mean, I'm sure you can remember it, too, like you can't really believe what you're reading.

Asher Larmie: Yeah.

Molly Moffat: When you discover it.

Asher Larmie: Is exactly the opposite of everything you've ever learned. It's it's yeah, like, you're reading like, it can't be true. How could it possibly be true. This is the opposite. It's yeah.

Molly Moffat: Absolutely. Yeah. You know that kind of cognitive dissonance you first get when you're like, "No, no." And then the more you read you're like, "Oh, yes." You know, like, actually, this completely ties in with what I hear people telling me, you know. And when I'm sitting there trying to give lifestyle advice, you know. Actually, social circumstances, social determinants of health are a massive part of that. You know. These people have been on diet after diet after diet. So this is this ties in with what I'm reading. And yeah, like, you say, it's like looking back through everything you've learned through a different pair of glasses.

And part of that is recognizing that, you know I had caused harm like I had been getting it wrong. But why are not more people talking about this? You know? And you want to tell everybody, don't you? You're like, we should be talking about this! Why are more people not talking about this?

Asher Larmie: But then it takes me back to the original experience you were talking about where we right from the start, as medical students, as junior doctors are put in some very uncomfortable positions which we accept. Because what do you know you? You are told from the beginning. You're very lucky to be here. We can replace you in a heartbeat. And we're investing all of this money into your education, you, you know, perform, you know, just perform like you're at a circus almost, and you just you are there to perform a role, the role of doctor. And when people say things to you like, "Don't be silly," and they're basically implying this person is not in pain.

It's really hard to turn around and say, "Excuse me, this patient is saying they're in pain. We need to believe them" because the culture is we don't.

Molly Moffat: Absolutely.

Asher Larmie: Is—if they say they're in pain, automatically be skeptical, make them prove it. It's not. We don't come from a place of like innocent until proven guilty. It's the opposite right, like...

Molly Moffat: Yeah.

Asher Larmie: You're lying until you can prove that you're not lying. And so it's really hard to then come to our colleagues, who often, you know we're all—we're all in the same position, many of us, I reckon a lot of us actually deep down inside are finding it quite conflicting that you know, on the one hand, this is how we're taught to behave, and, on the other hand, it doesn't feel quite right. But this is how we're taught to behave, and also the systems are in place to ensure that we do behave this way.

Molly Moffat: Yeah.

Asher Larmie: Right. But you you have to. We're talking earlier before we press record about like ticking boxes. And sometimes you're just sitting there in front of a patient, thinking, this is the stupidest thing I could possibly ask of you, but I have to.

And so the system also makes it really difficult. So I often think, why are more of our colleagues not talking about it, but it is quite difficult to to stand up against the system and say, "Yeah, I know you will think this, but actually, it's the complete opposite, by the way, and we should be doing this instead. Yeah, but just do everything differently," you know.

Molly Moffat: Yeah.

Asher Larmie: Quite hard. So yes, lifestyle medicine I had—I had a minute long dalliance with it. You obviously went in there longer.

Molly Moffat: Yeah, afraid so, yeah.

Asher Larmie: Well, yeah, hey. Actually, it got you to where you are today. So it's part of the journey. And I love that. And I think it's really interesting when you were talking about lifestyle medicine, and also at the same time eating disorders, because one, I would, I dare to say, can often lead to the other.

Molly Moffat: Right.

Asher Larmie: And yet oftentimes, when we're treating eating disorders, we often coming from a very weight centric place right.

Molly Moffat: Diet culture. Absolutely. Yeah. Diet culture is rife within eating disorder treatment spaces. It's wild.

Asher Larmie: Really wild. And I I don't wanna touch—I don't wanna touch that too much today because I feel like we could just go down a rabbit hole and never do anything else. And I have high hopes for this podcast that we might possibly possibly follow my kind of original plan. So you mentioned you work in community paediatrics.

Molly Moffat: I do. Yes.

Asher Larmie: Tell us about your community paediatrics job. What do you do?

Molly Moffat: Okay? So I mainly diagnose ADHD. And I support and treat ADHD. I always feel a bit uncomfortable saying the word treat, because I don't want to imply that I think it's something to be treated. But what I mean by that is, I prescribe medications that can support some of the challenges that children with ADHD experience. Yeah. And of course, many of the children, I see will also be autistic, and part of my job is to decide when I'm doing an ADHD assessment whether or not I think they need an autism assessment.

Asher Larmie: And you know, it just so happens, this is absolutely coincidental and not at all planned that we're coming up on autism awareness month. And I love the fact that you said, you know I treat the symptoms, or treat some of the challenges of ADHD, and at the same time, you know very much do sort of have to think about and work with people with autism, because the 2, as we both know, go very much hand in hand, and so segueing slightly, but not too much, into the fact that it's autism awareness month coming up second of April is awesome awareness day apparently, and April. The whole month of April is awesome awareness month, and this is very important to me, because, as those people who have been listening to me for a while will know I kind of am one of those late diagnosed or ADHD is autism, and ADHD, who kind of went, "Oh, wow! Look, my kids have it, and I think I might have it too."

And it was very funny when I finally sort of had was able to say it out loud and talk to some of my friends, almost all of whom, by the way...

Molly Moffat: Oh, what a surprise!

Asher Larmie: Because we all hang around each other, don't we? And we can talk about that in a minute. But and all of my friends were like, "Yes, yes, it wasn't like a shock. It was like, you knew that. Thanks very much, and and since then have noticed other people have come to me and say, 'Guess what Asher?' and I'm like, 'No, you don't say,' you know that's me like bringing a bit of sarcasm into it. I learned about sarcasm. I've also taught my children about sarcasm. The other day I said something sarcastically to my son, and he went, 'That was sarcasm.'"

Molly Moffat: That's it.

Asher Larmie: I was like, "Yeah, you got it well done."

Anyway, I would love to know your opinion about this. Some people say everyone's a little bit autistic, and this is all nonsense. It's a sham.

Molly Moffat: I know.

Asher Larmie: You've been watching one too many TikTok videos. If you go and check, you know, ask Google. It will tell you that autism is a lifelong developmental disability that affects how people communicate and interact with the world characterized by differences in social interaction, communication and behaviour.

Me personally, I struggle with both of these. I do not believe that we're all a little bit autistic, although I think it's fair to say that with most conditions, actually, not just with autism. Not that I think autism is a condition. I should put that out there, but actually, it's often the case that people will be able to find certain traits or find certain things, "Yeah, that happens to me. Of course." That's not the same as being autistic, and also don't like don't always like the language around, you know, autism, spectrum disorder.

Molly Moffat: Order.

Asher Larmie: And you know, developmental disability. Well, the disability bit, perhaps I think that that doesn't bother me so much, actually, but the sort of disorder the kind of we, the way that we've medicalised it, and also that we've said that the only way that you can be autistic is if a doctor.

Molly Moffat: Exactly.

Asher Larmie: Gives you a tick, does an assessment, and finally gives you the kind of like, "I'm signing you off congratulations," and then you're allowed to to kind of claim, which is odd, because, you know, you spend what? Half an hour, 45 min, an hour, Max, with a doctor once in your life. That's not the same, really, as living an entire life and knowing your own brain and body. But I would love to hear your much more sort of experienced, and, you know, learned opinion on this. Please.

Molly Moffat: I mean, I would entirely agree with you. And I think you've explained that perfectly that people get confused when people say things like, "We're all a little bit autistic" that actually, what we're referring to there is, if we look at individual autistic traits, most people would be able to relate to one or 2 of those autistic traits. And that's what people get confused with. But actually, when we look at, you know, somebody who's autistic, they have a number many of those autistic traits.

Similarly, you know, I could describe—let's say, for example, you know me personally, I'm very sensitive to smell. And other people will say, "Oh, you know, that's just normal. I don't like the smell of fish," you know, and it's like, "Well, okay, let's explore the difference there." I can give you a story of when I was so distressed by a particular smell that I was consumed by it for hours, couldn't think about anything else. That's different to not just liking it. So the context is really important. And the kind of—what's the word I'm trying to find? I don't want to say severity, but how extreme that reaction is is also really relevant.

Asher Larmie: Right very much so. I was walking in the park with my son the other day, and I just we went for a longer walk than I was expecting, and I noticed him getting more and more withdrawn, and I could see like he was getting really upset, and he is particularly sensitive sound, and always has been. And then he turned around and went, "Woodpecker," and I was like, "Oh, yes," and I could hear the woodpecker, which was really like you could hear that sound.

But what people don't seem to understand is that is so loud for him. He cannot not notice it. But there's the woodpecker, and there's all these other sounds. And he was saying, it's getting louder and louder, and he just can't like it hurts it physically, hurts them. So, you know. Sure people pick up on sounds. But I, for me it's not sound so much. It's other things. But it's usually for me different sensory issues, but for somebody who is so bothered by sound, I don't think people understand how loud those sounds are. They are intense, they don't, they're impossible to ignore, and I often got told, and I only realised this recently, this is going to be one of these situations where I'm basically venting and telling.

Molly Moffat: Fire away!

Asher Larmie: And I always used to be told how rude I was, because I used to listen into other people's conversations when we were in a crowded room.

Molly Moffat: Yeah.

Asher Larmie: I couldn't help it. And I didn't, and people would always be like, "You're so rude." I don't think people realize how loud these conversations were. They were right in my ear. I know they were sat over there, but I could hear everything they were saying, and then I was just like I couldn't help but be drawn into a conversation. Yeah, I couldn't. I can't block out the background noise just not possible to block out background noise that is exhausting.

Molly Moffat: Yes.

Asher Larmie: Is, of course, sorry I didn't mean to interrupt. I will let you get back to it. But you were talking about the difference between the kind of the intensity or the the way that it's perceived with the sensory differences. And are there other? Are there other things that other aspects that kind of differ, do you think? Yeah.

Molly Moffat: Yeah. So I mean, I would describe being autistic as kind of experiencing the world differently, communicating differently, experiencing and expressing emotions differently, you know, enjoying predictability, having a kind of monotropic approach to interests.

And of course, you know, the other really important point I'd like to make is that everybody who's autistic is different. And all of these things will affect each autistic person very differently. But you know, when people say, "Oh, we're all a bit autistic, or we're all a bit on the spectrum." It's really invalidating, really invalidating. And you know, a diagnosis for somebody can be really life changing and to have had that kind of realization, and to have been in a position where you understand yourself better, you have an improved sense of identity.

And you know you've kind of found your community to then have that kind of minimize and invalidated is horrible. Please don't do it.

Asher Larmie: Yes, kind of almost on a par with the man who's saying, "I've got a really bad headache," because I've got my meningitis on the nerves going.

Molly Moffat: Yeah.

Asher Larmie: Really a headache.

Molly Moffat: Grow up. Yeah.

Asher Larmie: Yeah. And so one of the things that I think and I personally felt thought this for a really long time, which shows just how little I knew about autism, but this idea that it is a spectrum. And so a lot of people I talk to will say, "Well, I can't possibly have autism because I have no problems speaking. I have no problems with language and communication." Or you know, there is this kind of horrible stereotype and a horrible trope, really, of what an autistic person behaves like, yeah, and "Well, that's not me." So that's and and then there's also this confusion about like, you're either like this way on the spectrum or this way on the spectrum. You know it's this idea that, like you're either high need or low need, I guess, is the word I'm looking for. And then there was this kind of we don't use the term anymore. But Asperger's was there around for a long time, which threw even more confusion into the loop. So I wonder if you could unmodel that for us a little bit, Molly? No pressure.

Molly Moffat: Yeah, I mean, I think functioning labels are extremely unhelpful and actually very harmful. Because when we as an outsider look in and judge somebody's level of functioning. We're basing that on what we can see.

And you know, it also comes from a place of ableism, because we assume that somebody who is, you know, wheelchair bound. Non-speaking is not functioning as well as somebody who has got a job, etc. etc.

Asher Larmie: Yes.

Molly Moffat: And also we don't know anything about that person, you know, who is supposedly high functioning, you know. Yes, they're going to a job. Yes, they, you know, have got a family, and they're managing that responsibility. But what we don't see is we don't see the fallout at the end of the day. We don't see the impact on their mental health. We don't see how utterly exhausted they feel.

Yeah. So yeah, functioning labels are extremely unhelpful. And I'm so glad that we're moving away from them because they tell us so little, and I do believe they are rooted in Ableism.

Asher Larmie: And so you you mentioned obviously, sensory processing is one of the ways. So I'm kind of thinking people might be listening to this right now. And if you're listening to this right now, and if you've been following Asher for a long time, there's a chance. This is not—there's not like a definite like diagnostic tool. But there's a chance, you might be a little bit neurodivergent. And we do, I think, and I'm sure, Molly, you can explain this a little bit better. But I have noticed that we tend to find, like you, said our group of people that we can relate to, and that make sense to us and help us make sense of the world a little bit. And once we find them, we kind of stick together. And so, yeah, I'm quite conscious of the fact that a lot of people might be listening, going, "It's possible I might be autistic, but I but I don't believe myself because I you know there is that sort of almost imposter syndrome, or like self doubt. If I if I try out that label, it'll always be like everybody's. It was just a TikTok video. Or it's just yeah. That's what everyone's doing. I don't want to jump on the bandwagon, and it's not as bad as everybody else, you know, and all of these thoughts that we're having. So if if you can imagine somebody listening in right now who may be toying with the idea that that you know they've always been a little bit quirky, a little bit different, a little bit rude.

Molly Moffat: I forgot.

Asher Larmie: Told it was rude, it was so rude, he was so mean. And you're so what's the word? Not callous? That's not the word, but like unfeeling, like, you know, you don't like...

Molly Moffat: Cold?

Asher Larmie: Oh, can you think of the word, Molly? Like when you don't care about people? No cold?

Molly Moffat: Yeah, a bit cold. Yeah.

Asher Larmie: Yeah, a bit cold. Yeah. So maybe those are words that have been thrown at you from time to time. Maybe when you were young, because, you know, this is something that happens from childhood. So yeah, it might be something that you've always grown up with, and you might be really good at compensating for it or masking, which is the word that people use to describe, like the fact that you know you've you've been told you're rude so many times that now you've learned to not be rude, but when you're your natural, normal self you can be a bit abrupt for a bit, you know, the way you communicate isn't quite the same as your peers. So imagine there's this person out there listening to this podcast. Right now. And they're thinking, "Hmm, wonder. If that's me, what what would you tell them? What would you advise them, or what might you ask them?

Molly Moffat: I mean, I suppose the first thing I would say to somebody is, you know, usually, if you're thinking it, I'm wondering you probably are. And you know, I think, yeah, your point about finding each other is really relevant. And you know, if you're if most of your friends are autistic. There's a reason for that. You know. Have you heard of the double empathy phenomenon?

Asher Larmie: No! Tell us.

Molly Moffat: Okay. So this was a theory which was written by a man called Damien Milton, who is an autistic academic. And it was in response to this idea that autistic people are kind of lacking empathy. And actually, what he said was that it wasn't a lack of empathy. It was a mismatch in empathy between neurotypicals and autistic people. So it was that mismatch in how people experience and express empathy that was causing neurotypical people to see autistic people as lacking empathy.

Asher Larmie: Wow!

Molly Moffat: So if we think about why, it might be that you're autistic, and you naturally have found yourself around autistic people. It's because there isn't that mismatch, you know. Obviously, we'll all be different because we're all individuals. But you know there will be those commonalities which will mean that we're kind of coming from the same place. And there's not that mismatch.

Asher Larmie: That's just so awesome. What? What was the difference? I'm curious, because when you don't know what it's like to be neurotypical, what does it mean to experience empathy as a neurotypical? I only know what it means to experience empathy as me, and I do know that I experience empathy a lot. Sometimes I feel to the point of exhaustion and to the point of I wish I could turn it off, because it's quite, you know, and there's also that sense of justice as well. It has to be fair, and if it's not fair, I cannot, cannot tolerate it.

Molly Moffat: Yeah, I mean me, too. So I wouldn't be able to tell you very much about the typical experience of empathy, either. And actually how I came to my autism diagnosis was first of all recognizing that I was a highly sensitive person. Then, recognizing that I was an empath, and then that kind of yeah. Then autism came off the back of that.

Asher Larmie: That's oh, that's so helpful to hear. So if you're listening in, you know, like being empathetic does not exclude you from an autism diagnosis actually often is as a sign saying that this might be the case. Not all empathetic people, of course, are autistic. But it's yeah.

Molly Moffat: Yeah.

Asher Larmie: That makes, yes.

Molly Moffat: So I suppose in answer to your question, if if somebody was curious, then I would really encourage them to explore that, and you know, to recognize that self diagnosis is entirely valid within the autistic community. And if you're a true autistic ally, you will agree with that. And you know I get very annoyed by the whole, "Oh, you know misinformation on TikTok," and actually, for me, the most dangerous misinformation is that held by people in power. You know, TikTok videos, they can be helpful, I'm sure some of them are unhelpful and do have some misinformation. But, like I said, I'm less concerned about that than I am somebody who should know better, and is in a position of power that holds misinformation about autism. And you know, certainly when I think about my own teaching at medical school around autism. And actually, the way I used to approach autism even until 10 years ago, you know it was so outdated, and I cringe so badly when I think about the things I used to think and say about it.

Asher Larmie: Ditto, and I would say it was probably less than 10 years. I've been awakened much more recently, and I love that you mentioned self-diagnosis, because I think that's really important. I also we were talking, and I can't remember if we pressed record or not. But we were talking about the idea that that you know it's only supposedly valid once you have this this diagnosis from a doctor, you know. Who says this? Is it? "Congratulations you have passed. You are officially autistic," and until then it doesn't feel valid, doesn't feel real.

Do you agree as a doctor and as somebody who works, I know you predominantly diagnose ADHD. But I think actually, the 2 probably feel the same way. I think people with ADHD also feel that way. I don't have ADHD until a doctor tells me I have ADHD, do you think that's true? Or do you think self-diagnosis, I mean you sort of alluded to it already? But.

Molly Moffat: You know, I think self diagnosis is entirely valid. I think the diagnostic criteria has some updating to do, shall we say? And you know it is based on boys from a long time ago.

Asher Larmie: Yeah.

Molly Moffat: So? Yes, no, I I very much believe in self-diagnosis. But, on the other hand, of course I do understand, and you know I sought a diagnosis for myself, and the reason I did that was for me. Personally, I needed the external validation. I needed somebody else to agree with me and and I completely understand why people would feel the same way.

Asher Larmie: Yes, absolutely. Both things are absolutely true. I think self diagnosis is very valid. I also completely understand the need to then have somebody say yes, because and I think that's part of being neurodivergent is that we really need to understand. And and we won't stop until we do. And then once we understand. Then we're like, "Oh, okay, good." And so for me, there is this part that's just like, but I just need some confirmation, please, and then that will stop the questioning and the ruminating. And the is it? Or isn't it? Or you know all of that silence, those voices, I guess, is.

Molly Moffat: Yeah, I wish I could have another assessment now, actually, because I'm kind of—so I was diagnosed in 2021. So I'm kind of 4 years down the line, and I feel like I would answer the questions differently now to how I did 4 years ago, because, you know, I've kind of understood myself a little bit more. I've unpicked what is me versus what is my authentic self versus what is my kind of, you know, camouflage self. What have I taught myself to do versus what actually feels right? Yeah.

Asher Larmie: We are, too, doctors who, as you said, whereas we were talking earlier, see between 30 to 35 in general practice, 30 to 35 interactions per day.

Molly Moffat: Yeah.

Asher Larmie: Each one lasting 10 to 15 min longer. It depends how efficient you are, each one being extremely by risk and requiring a lot of risk assessment, each one requiring your full attention.

Molly Moffat: Yep.

Asher Larmie: We voluntarily chose. I mean, I'm sure we could go back and figure out what we did. But we did choose to go into this profession, and we were in this profession have been in this profession for quite some time. It's not the ideal profession for an autistic person, but yet here we are, and we're not the only 2, I'm sure of it. What's that about?

Molly Moffat: Gosh, that's a big question. I don't know. I mean, I'm always actually quite surprised by how many autistic people do thrive in general practice.

Molly Moffat: And you know, I hear lots of people talking about kind of really enjoying the decision making, really enjoying the diversity, you know, moving quickly, mostly people with ADHD, but moving quickly between each patient.

Asher Larmie: Yeah.

Molly Moffat: So again, I guess it comes back to kind of yeah, everybody being a little bit different, even if we are all autistic, and it working for someone working for others. But yeah.

Asher Larmie: But but the point is that we go home, and we are exhausted, but in a way that I'm not sure all of my GP colleagues experience exhaustion.

Molly Moffat: No, that is a very good point. That is a very good point. Actually, yes, even those people that thrive.

Asher Larmie: Yeah.

Molly Moffat: Yeah, how much do they have left to give by the end of the day.

Asher Larmie: Oh, gosh, yeah, you and I can't. There is a limit to how much I can do of that. It's just physically limited. My brain simply doesn't have the capacity to to do more than and for me it was 2 days, but that was before I couldn't do one now but but yes, it's it's an interesting thing. I wonder you mentioned about the fact that a lot of the research is done on boys, and we know that, statistically speaking, boys are far more likely to be diagnosed autistic than girls. And when I say, boys versus girls, I very much include me in the girls category. We both know that I do not identify as a girl or a woman, so I guess it's those of us who were socialized from a young age as girls, you know. Yeah. And therefore this very much fits.

And there are many people who have told me that there is difference. And do you do you know, or can you explain why? Perhaps we are more likely to diagnose boys, statistically speaking, than girls.

Molly Moffat: I mean, I think it very much goes back to that research and the diagnostic criteria being based on boys, you know the stereotypes that we hold. And I think about my understanding of autism before I entered this space, you know, was kind of based on those Rain Man stereotypes of boys that you know sit and watch trains and aeroplanes and can recite, you know, all the way tracks across the UK.

And you know, when I was referring to myself, I guess you know I was talking about unpicking how much of me is my authentic self versus me masking? And I think that's true for a lot of women, and actually, probably young girls. You know, we are conditioned as girls, females, women to behave in particular ways which I very much think affects some of those autistic traits. So you know, particularly around kind of social communication, which obviously means that we present differently, which can make that diagnosis, that diagnostic criteria quite confusing.

Asher Larmie: See, looking back when I was very young, like, you know, the earliest memories I have, I didn't socialize at all. I was that kid that was very much on the periphery, and I had only one other friend who was autistic, and so I didn't. I didn't do socializing. I didn't understand playgrounds, and I was notorious. My mother used to complain about the fact. She couldn't take me anywhere, and but I did learn, and I actually got quite good at it. And I think now I don't particularly ever want to interact. I have to force myself to socialize. Now. It's very much like I think it's important that you don't completely isolate yourself as a you work from home now you probably need to go out and be around people from time to time, but if I could I wouldn't, because it's it's not particularly enjoyable to me.

But 5, 10 years ago I was the life and soul of the party. I was the extrovert. I told everyone I was an extrovert. I told everyone I got my energy from communicating being around people. Do you relate to that?

Molly Moffat: And so I was a very sociable teenager and young adult, and my parents would describe me as very sociable. And actually my mum talks about when I was a young child. She used to have to constantly keep me entertained, kind of, you know, taking me to other people's houses, but I was also extremely socially anxious. And found socializing utterly exhausting. And I, you know, before I understood myself and again, this is why diagnosis is so important. I didn't set those boundaries for myself, I didn't advocate for myself, and I put myself. I forced myself into situations that were uncomfortable and anxiety provoking because of these expectations that I put that society put upon me, and then I put upon myself to socialize. So you know. Now would I go, you know. Would I go to a nightclub? No, absolutely no way, because it would bring me 0 joy.

Asher Larmie: Yeah.

Molly Moffat: But I used to force myself to do things like that.

Asher Larmie: Yeah, exactly. Exactly. And this, actually, this links into something I wanted to talk with you about. Bear with me. Follow my train of thought. So one of the things that you do is you mentioned that you did you say it was a did you call it a private business. Tell me, what did you refer.

Molly Moffat: I don't. I think I said business, but I'm struggling to find the right word for it private practice. I don't know. Yeah.

Asher Larmie: Yes, yeah. Whatever private practice, whatever folks it is, what it is, it actually, it is something quite new and quite different. It doesn't fit into any real box. And that's what makes it so awesome. But I'm obviously going to put Molly's the links to all of Molly's Instagram Page and Molly's website in the show notes. Please go and have a look, but I'm going to read from it, which I find really helpful, because we were talking about masking and sometimes forcing us, not having these boundaries and forcing ourselves into very uncomfortable into uncomfortable situations. And I do think food absolutely comes into this, and I really love this pick from your website, which I'm obsessed with, I challenge the mainstream view of nutrition, which is very binary. Moving away from the idea of food, a food being either good or bad, or healthy, or unhealthy, and moving towards thinking of food as something that can be enjoyed and provides many things as well as nutrition. For me, food can be about connection, memories, and enjoyment.

Alongside this I also consider health to be very complex and multifaceted, and so much more than how many vegetables a child eats.

Molly Moffat: No.

Asher Larmie: One of the things that I think that you help people to do but correct me if I'm wrong, is to well, am I right saying unmask when it comes to eating. Is that a good way of putting.

Molly Moffat: Yeah, absolutely be their authentic selves.

Asher Larmie: Right.

Molly Moffat: Feel safe enough to be their authentic selves and understand their feeding behaviors. Help the parents understand those feeding differences and feeding behaviors, and understand what accommodations can be put in place to support that child, and you know the goal. The goal is never for a child to eat more pieces of carrots, or eat or eat a piece of broccoli. You know the goal is for the child to be as safe as they can around food and for their needs to be being met.

Asher Larmie: Amazing. And I want to say, as a parent of neurodivergent children, and not realising this until they were a little bit older, I spend my life trying to create meals that somehow accommodate not just one, I know 3 children with different.

Molly Moffat: Different.

Asher Larmie: Food sensitivities, the taste... peppers, I mean red bell peppers, delicious texture. Absolutely not. Not a chance. Raw god, no, a raw tomato disgusting, a cooked tomato fine, and and so on, and so forth. And of course there's also the additional thing with with the ADHD of "I really, really really love this food until I stop liking it altogether done" so I've often stocked up on stuff, and then no.

Molly Moffat: And then suddenly, they'll change their minds. Yeah.

Asher Larmie: Okay, thanks. It's quite exhausting. One of the things that I congratulate myself is that I was, I never made them feel bad for this is that, you know, and I didn't realise at the time that what was going on. I just knew that they were very picky eaters, and so I just I think there must have been some eye rolls sometimes, and but now I'm able to sort of say, "Well, I know why this is happening," and we talk about it. My kids are older now. But so what's what are some of the things that you come across in your line of work?

Molly Moffat: I mean, I would say that sensory preferences form a large part of what I support families with. So, and you know, that's much more than just the taste of food, or even just the texture of food. It's about smells. It's about seating. It's about cutlery, it's about temperature. It's about the environment, you know, the noise of other people eating the noise of knives and forks, screeching on plates, the kind of hustle and bustle. All of those things, you know, can really impact a child's experience of around food.

What else do I see. I mean, I hear a lot of parents describe binge eating. They don't use those words, but you know they describe their child being, you know, out of control around food and seeking, you know, quote unquote junk food. That's a really big part of what I see, particularly with ADHD kids. And you know, executive functioning challenges, which, of course, then plays into the parents. Because, you know, if you've got a neurodivergent kid, chances are one of the parents will be neurodivergent. And so they may be struggling with the executive functioning around, like, you say, feeding multiple different children with multiple different needs and themselves on top of the exhaustion and energy that's involved with parenting a child with different needs. Anyway.

Asher Larmie: Right. And what oh, there's so many things you said I was like, oh, my gosh, all of those things! And we don't. We don't necessarily think about cutlery scripting against, you know. That's so true. I used to really believed that food had to be eaten at the dining table that we had to sit down and eat a meal together.

Molly Moffat: Oh, that's so interesting, because that's something that I've really changed my attitude towards even over the last 2 years in even since being in the anti diet space. When I entered it I was very much like, you know. It's not about what the child eats. It's about how they eat. It's about that connection. It's about being with their family mealtimes, and I placed like so much importance on this kind of meal time.

Asher Larmie: Yes.

Molly Moffat: And actually, I think that's you know, I think that can be just as harmful as focusing on how many carrots they're eating. Because, as you said, like that can feel unsafe. That can feel very unpleasant to many children, my daughter included. And actually, what we've noticed is, since, you know, reducing that pressure and allowing my daughter to not eat with us and eat separately, there's more chance that she actually will eat with us, because she has that reassurance. She has that feeling of safety that it's okay. She can eat somewhere else if it's too much.

Asher Larmie: Yeah. Oh, my gosh, once I release. Because and I think a lot about a lot of that came from diet culture as well like you're not allowed to distract yourself whilst you're eating, because.

Molly Moffat: Yes, in BASUK on the food, and it's got to be mindful. Yes.

Asher Larmie: Yes, but actually I, you know, for my for my children. Often it involves you know, headphones on, and like cutting off the sound from the world that that's actually the most therapeutic thing for them when it comes to meeting or or listening to music, or God forbid on their screens, you know.

Molly Moffat: God forbid. Yeah.

Asher Larmie: Terrible parenting like I allow my children to be on their screens and watch Youtube class. I fully admit I'm a terrible parent. That's fine. Judge me all you like, but this this idea of also it was also the kind of it was at the end of the day, and everyone was tired. I was tired, we were all tired, and we were trying to form.

Molly Moffat: Force, yes.

Asher Larmie: Force, a connection.

Molly Moffat: Exactly.

Asher Larmie: And we're a really close family. We don't. It's not that we don't love and care about each other. We can absolutely form this connection outside of real time.

Molly Moffat: Exactly. You don't need a meal time to do that. And and that's been really quite revolutionary for me. And yeah, it again. It goes back to forgetting the shoulds, forgetting those neurotypical standards that tell us that a happy, good family sits at the table and all eats together and talks about their day, and no, for neurodivergent families that can look very different. That connection can look so different. And it, it can, you know, appear in different ways. It doesn't have to be that I'm cringing, actually, because I'm remembering a phase I went through where I did this thing, where I asked each child. I had like a set of questions that I asked each of my 3 children at the mealtimes, as like kind of forced.

Asher Larmie: Yeah, I did something similar. Yeah, I get you.

Molly Moffat: Like, you know. And and you know, my kids are, demand avoidant, like probably the worst thing I possibly could have done to them. Yeah. You live in.

Asher Larmie: We do. Yeah? And again, I think I think this is where wellness, culture, you know, and diet, wellness and diet culture kind of mixes in with with everything else. And this, like you said this idea of the good family, the healthy family, the the right family, does it this way, and there are just a million different ways to be a family. And it also, again, there's a lot of ableism. There's a lot of classism in there as well. Yeah.

Molly Moffat: Definitely, definitely, so much cautism.

Asher Larmie: So like, you know, if not, everybody has a dining table to sit around. Folks.

Molly Moffat: Exactly.

Asher Larmie: Not everybody has parents who are able to be at home at a suitable time for eating. If you're working shifts and stuff like you just can't be present. And so the idea that that's the only way you can do it is, is very frustrating. But I learned those things growing up, and I was told that was the correct thing to do, and I always felt very ashamed, but actually, to be honest by the end of the day. I really don't want to do any peopling, even with the people I love. I just want, you know, as my daughter often says, "I just want to be in my room in the dark. Turn off the light."

Molly Moffat: Yeah.

Asher Larmie: Fair enough, because that's how she deals with it, and is very good actually, at saying about social. She'll she'll call it her social energy levels very sort of in her mind, I can tell. She's envisioning a game, and like the kind of you know, that kind of battery that slowly dies down until.

Molly Moffat: Yeah.

Asher Larmie: It's just she's just envisioning a low battery, and she'll often say low battery or low energy levels off. I'm going. Leave me alone. Don't come back to me until you know, until give me a few hours, which is really great. But I you know, I do remember feeling that way and being told that that was absolutely wrong. Oh, yeah. And so how do we? How do we support parents, or even it doesn't have to be a parent. It could be you as an adult actually, who perhaps has ADHD and is seeking certain foods, and then is as hold that they've got that they're binge eating, or believes that they're binge eating, or they've got a child that they think has binge eating, and that's terrible, because they might get fat. Or maybe they are fat, and that's even worse, because.

Molly Moffat: Isn't know.

Asher Larmie: What's the end of the world? What would you say to somebody in that situation?

Molly Moffat: I mean, a lot of what I do is about changing that mindset in terms of what a healthy person or a healthy child looks like, and understanding that health is so much more than you know how many pieces of broccoli a child eats. And actually, when we're looking at a child. Let's zoom out a little bit and think about what else we want to be thinking about. Think about this child in 20 years time, right? And what else we want for that child.

And you know most parents can recognize that actually, in 20 years time, not. They don't just want their kid to be eating broccoli. They want their kid to be, you know, happy, confident, with their body, confident around food, have that kind of healthy relationship with food. So that's a really important first step. And one of the main things that I do with families and parents which obviously takes a long time because there's a lot of unlearning there, and you know I have full compassion for for families, because, of course, we are consumed by all these messages about healthy eating and what we should be feeding our children, you know. You know, there is serious moral panic going on at the moment around ultra processed foods, for example.

So of course, I understand why parents feel anxious when they're, you know, confronted by a child who is only eating packets of crisp, for example. But yeah. So what I try and encourage them to recognize is that actually, that relationship with food is really important. And particularly when you've got a neurodivergent child having that child feel safe enough to be their authentic selves, and having their sensory needs met, is a really important aspect of their health.

Asher Larmie: Right.

Molly Moffat: And when we're thinking about binging, the starting point is always a binge will come from a place of restriction, and that might be self-inflicted restriction through dieting, or it might be restriction as a result of an ADHD kid who is distracted, forgetful, doesn't have, you know, hasn't been able to make lunch for themselves, or is on ADHD medication that's suppressing their appetite. So, therefore, the solution is not to restrict any further. The solution is to think about how we can prevent them being in this state of restriction.

So you know, ensuring kind of regular access to food throughout the day. For example, I talk to my kids in my ADHD clinic about this a lot that you know, when they're on ADHD medication. They're not going to feel so much like eating, having a big lunch, so we need to make sure that they've got access to smaller snacks throughout the day. So they're not getting home, and they're not completely ravenous.

Asher Larmie: Right. And this could be very problematic at school, because, you know, I've got a child who will really struggle to eat breakfast. Just force, you know, almost has to force it down their their gullet, just not in the mood for eating when they first wake up and then cannot handle food like, just it's, it's lunch at school. That's the problem. It's the noise. It's the smells. It's all of that stuff. It's it's too much.

And yeah, I'm going to be really, really. 1st of all, she's old enough to make her own food now, so I let her pack her own lunch. Do not comment on what she puts in there. She can put whatever she wants in there, and I don't comment, but I'm perfectly aware of the fact that my daughter makes herself a nutella sandwich every day for lunch. That is her. That is what she eats, and I don't comment, but that is, you know, that is it? And and I think that me a few years ago, would really have struggled with that.

And what do you like? What do you say to people who are like, you know, my children only eat white bread, white pasta, white food often beige food is quite a you know. I'll only eat you if it's a beach, cannot force my children to eat fruits, it's just not possible I would have to literally shove it into their mouths. That would be awful. So what do you say to people who are really worried? My child's not getting enough nutrition.

Molly Moffat: So multivitamins are great things, and of course, you know, it's important to think about how we give those, particularly when you've got a child who is, you know, particularly a child with afid, for example. But there are usually ways that you can get a multivitamin into a child, you know. Are they growing? Are they pooing and weeing, you know, if you kind of ticked all those things then mostly okay. And then, like, you say, it's well, we've got a child who will only eat a nutella sandwich, and when you try and give them fruit and vegetables they get very distressed.

So you know you've got 2 options. One is you continue forcing fruit and vegetables and creating distress. Or the second option is, you think about the environment. You think about what other things that you can be doing. You know you can not be commenting on that food and creating those positive relationships and behaviours around food and modeling that yourself, and that is what I would encourage parents to, and that's why hope I managed to do.

Asher Larmie: Yeah, that's amazing. And of course, when my children are at home and in a safe space, they have a much more varied palate. And I've noticed that it's usually in stressful environments like school. And it's, you know, there's not much we can do about it. But I was also the same when I was at work it was really difficult to eat at work. I don't know. You would eat lunch at your desk type of GP.

Molly Moffat: Your common in the common room type of thing.

Asher Larmie: Great.

Molly Moffat: No, no, no, yeah.

Asher Larmie: Yeah, that's, you know. Actually, it's better to eat lunch at the desk than to eat lunch in public. But still it's not. It's not. It's not relaxing, and we can't enjoy food. And I really like that. You said food can be about connection, memories and enjoyment.

Molly Moffat: Excuse me.

Asher Larmie: So important, isn't it?

Molly Moffat: And I think we really have lost that. I mean honestly, I think we totally overstate the importance of food and nutrition, and I realize I'm not a dietician and nutritionist, so I'll say that a little bit nervous. But you know, I think we're obsessed, and it means that we have stopped enjoying food, and, like you say, we see it purely for its nutritional value. You know, we look at food, and that's all we see. And actually, food has so much more to offer. You know, when I think about black orange and liquorice sweets, I think about my grandma, you know, when I think about fish and chips, I think about the time that went to, you know Cornwall with a friend, food can evoke memories.

And isn't that great? You know.

Asher Larmie: Yeah, and be extremely comforting and.

Molly Moffat: Absolutely. And there's no. Again, diet culture has created negative associations with kind of, you know, comfort eating, for example, and like what's wrong with when you've had a good day or a bad day, having a you know, whatever you want to eat.

Asher Larmie: Yeah, yes, and and this is not. This is not judgment, but a lot of people will, you know, have a bad day and have a glass of wine. No judgment, if that's what you do, but that is in general considered to be more acceptable than comfort eating.

Molly Moffat: You might be able to get away with a glass of wine, but but not a cheeseburger, or whatever it is that you're craving.

Asher Larmie: And this has been an amazing conversation. I have really appreciated it. I'm sure a lot of people are going to have be feeling the same way. If someone's listening, they're like, "I like this. Dr. Molly Moffat is rather incredible. How do I work with her?" How do they work with you?

Molly Moffat: So you can email me. My email address is hello@drmollymoffet.co.uk, and my website is www.drmollymoffet.co.uk, and I would really love to hear from you. I love working with families and getting to know you.

Asher Larmie: Yeah. And honestly, I feel like you are meeting a need that really nobody else is meeting. There are very few people, and as somebody who has gone through the services, and, like, you know, actually like done this as a parent, I can quite safely say that there is no support around this area around you, and all of the support that's available out there is is laced with diet culture. And it's kind of like, you know, we were talking we touched on eating disorders as well. You know it's the support that's available is just so completely and utterly weight centric that I don't feel comfortable, taking my fat children to see somebody, even a nutritionist or a dietician who specializes in neurodivergence because I don't think they're coming at it from a weight, inclusive perspective. So I'm going to go out there and say you're the only one

Molly Moffat: And I think they.

Asher Larmie: You might not be. But I'm putting it out there. You are. You're the only one that I recommend. How's that? So I'm going to link you in the in the notes to this, whether you're watching on Youtube, or if you're listening in, podcast just click on the link. Go to Molly's. Do you see adults as well? Do you mainly just see children?

Molly Moffat: Just, children, yeah, yeah.

Asher Larmie: So I thought, so go to and pass it on. If you've listened to this podcast and you're like, "Oh, I know someone who's got a neurodivergent kid." Please pass it on because they are probably really struggling with it. I've yet to meet a parent of a neurodivergent kid that goes "Oh, mealtimes piece of cake!"

Molly Moffat: "Easy, peasy." Yeah.

Asher Larmie: Easy. It's just not a thing, and it's not something we talk about, and it's something we're very ashamed of, and it's something that we keep quite, you know, took me a lot to come out here and say, "Hey, I let my child eat a nutella sandwich every day, and I don't feel ashamed of it." I wouldn't have been able to say that a while ago, because that does sound like very negligent parenting, and I'm sure I will be judged by certain people. But that's fine, because that is the reality of my situation. So please pass this on. Pass Molly's details on, and honestly thank you so much for coming on. I really appreciate you.

Molly Moffat: Thanks so much for having me. It's been great to chat.