Eating disorders are strongly associated with low self‐esteem and poor body image. [1, 2] Self-esteem and body image must be improved in order to heal fully from an eating disorder because we can’t change a behavior until we change the predisposing factors that drive that behavior. 
If we tell a child that she’s beautiful and doesn’t need to starve herself anymore, we are unlikely to help her recover from an eating disorder because we have maintained the focus on her body and done nothing to change her underlying beliefs about her body and her self.
We tend to think of girls when we think of body image problems, but poor body image impacts boys, too. Rates of male eating disorders are increasing rapidly, alongside studies finding that men’s bodies are increasingly being objectified in the media. Studies find that males display substantial body dissatisfaction and that this dissatisfaction is closely associated with eating disorders and low self-esteem. 
While we may think the best way to help our child recover from an eating disorder is to educate them about the dangers of eating disorder behaviors, what we really need to do is help our kids see themselves as worthy of love and respect regardless of their eating habits, weight, exercise patterns, or any other behavior. 
This is good news for parents. We don’t have to learn everything about nutrition and body image to have a positive impact on a child’s eating disorder recovery. We just need to learn how to help our child see themselves as worthy, and this is something that parents are uniquely positioned to do well.
But please use caution – parents can cause unintentional harm if they approach self-esteem automatically and without research. We need to learn about the words and behaviors that actually increase our children’s self-esteem rather than acting on instinct, not because we are bad people, but just because we live in a culture that inflicts accidental psychological damage on a daily basis.
Steps to improve a child’s self-esteem
Here are some things parents can do to improve a child’s self-esteem:
1. Offer choices. Help your child experience “agency” – the ability to influence their own life outcomes – by not limiting them to one option. They may need to do homework, but they can choose the order in which to do their homework. They may need to take out the trash by 9 p.m., but they can choose when they do it before then.
2. Don’t jump in. It can be tempting to jump in and solve problems for our kids or give them step by step instructions for solving a problem. This is especially hard when we are trying to help a child recover from an eating disorder. But self-esteem comes from believing that you can accomplish tasks by yourself. We have to be patient and let our kids solve their own problems whenever possible.
3. Work against perfectionism. Perfectionism is an underlying factor in many eating disorders. Perfectionism is the belief that if I do something wrong I will lose love and admiration. Parents can help kids recover from perfectionism by openly acknowledging mistakes without shame or blame and reminding kids who are suffering because they made a mistake that nobody is perfect and everybody makes mistakes.
4. Praise your child’s positive actions. Our kids crave our praise, but it’s important to avoid common praise pitfalls. Praise like “you’re so talented!” rings hollow and also demonstrates a fixed mindset: either you’re talented or you’re not. Parents should embrace the growth mindset by praising their children for how they approach difficult things in life. And it’s important to never praise a child for their body size or eating behaviors.
5. Give them responsibility. Even in the midst of eating disorder treatment, appropriate household chores should be a part of your child’s life. Participating in the household chores helps children feel they are competent and bolsters their problem-solving skills. Be careful about how you set this up – we don’t want to constantly remind our child of their responsibility – nagging has a negative impact on self-esteem.
6. Give them one-on-one time. Each child wants to feel unique and special in their parents’ eyes. Take time to spend time alone with your child at least once per week. Even if they resist your efforts, keep showing up. Our kids need us more than we (or they!) know, even as they grow up. Don’t let your child’s social schedule get in the way of time for you to connect with them and build your parent-child bond. Being close with a parent has a significant impact on lifetime self-esteem.
A child must work towards self-esteem on many levels, but a parent can impact a child’s self-esteem by providing consistent acceptance and reassurance. It’s important to know that “acceptance” is not the same as “approval.” For example, you may not approve of your child’s eating disorder, but you can still accept your child as they are. Here are some statements we can use to demonstrate unconditional acceptance:
- I love you.
- I admire you.
- I accept you.
- I hear you.
- I believe you.
- I understand.
- I don’t need you to be perfect.
The only caveat is that you need to actually believe these things when you say them. Kids have a fine-tuned bullshit meter, so make sure you are speaking the truth. If you can’t say these things truthfully, then please seek help from a therapist or counselor. You may have some personal work you need to undergo before you can provide your child with unconditional acceptance.
Also, never add the word “but” to any of these statements. When we say “I love you, but I wish you would take the trash out,” we are suggesting that our love is conditional on our child’s behavior. The whole point of saying these things is to be unconditional in our love and approval.
“Loving someone fully and without judgment is the opposite of being a weak pushover. It requires tremendous strength, fortitude, emotional maturity, and self-awareness.” — Andrea Miller, Radical Acceptance: The Secret to Happy, Lasting Love
Avoid body image pitfalls
As we help a child build stronger self-esteem and body image, we must avoid giving body-based feedback. Here are a few rules about giving feedback to a child who has low self-esteem and negative body image:
- Do not provide feedback on a body part (e.g. your legs are so strong! You have such a tiny waist! Your biceps are so big!)
- Do not provide feedback on body weight (e.g. you’ve gained weight! You’ve lost weight!)
- Do not provide feedback on physical appearance (e.g. that’s so slimming on you! You look fat in that!)
- Avoid feedback on body and eating behaviors (e.g. you finished everything! You ran every day this week!)
- Avoid the words “good” and “bad” (e.g. you’re such a good student! You ate really badly yesterday.)
To increase self-esteem in a child who has an eating disorder we must focus on the non-body and non-eating or exercise aspects of our child’s life. We also want to avoid triggering their desire to be “good” via behaviors. We want our child to believe they are inherently good, regardless of what they do or how they appear.
Positive feedback with the growth mindset
Giving positive feedback can be difficult so it can be helpful to review information about the “Growth Mindset” that many teachers are learning to help children go from feeling fixed and stuck to feeling they can accomplish hard things.
|Fixed Mindset||Growth Mindset|
|You are so creative.||I love how you approached that project with so much patience and thought.|
|You are a great swimmer.||It’s great how you make time for swim practice.|
|You’re so smart.||You really studied for this test – I’m proud of you.|
|You’re so talented.||It makes me happy to hear you practicing the violin every day.|
|You’re so athletic.||You work so hard at soccer, and being on the team seems to make you happy.|
|I knew you could do it.||I like the way you tried all kinds of strategies until you finally got it.|
|You’re such a good friend.||I love the way you showed up for your friend when she really needed you.|
Remember that building a child’s self-esteem and body image is not about telling them they are great – it’s about building their own perception of themselves as worthy human beings. Self-esteem and positive body image can be influenced by a parent’s unconditional love and approval, but it ultimately has to come from within the person. This is a long-term effort. Invest time and energy in learning more about self-esteem and body image and just keep working towards it.
References Self‐esteem, eating problems, and psychological well‐being in a cohort of schoolgirls aged 15‐16: A questionnaire and interview study Eric J. Button Philippa Loan Jo Davies Edmund J. S. Sonuga‐Barke International Journal of Eating Disorders January 1997  Self‐esteem, personality, and eating disorders: Baseline assessment of a prospective population‐based cohort, Pilar Gual Marta Pérez‐Gaspar Miguel Angel Martínez‐González Francisca Lahortiga Jokin de Irala‐Estévez Salvador Cervera‐Enguix, International Journal of Eating Disorders, March 2002  e.g., body image; Bandura, 1986  Biceps and Body Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms Roberto Olivardia, Harrison G. Pope Jr., John J. Borowiecki III, and Geoffrey H. Cohane Psychology of Men & Masculinity, 2004  Garner, 1985; Carter, Stewart, Dunn, & Fairburn, 1997; Mann et al., 1997