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What parents need to know about Family Based Treatment (FBT) for eating disorder recovery

FBT for eating disorder recovery

Erin was terrified when her 13-year-old daughter was diagnosed with anorexia. She spent a few months just trying to get her feet under her as she navigated the care system and tried to figure out what she was supposed to do to help her daughter get better.

“I felt like I was running through quicksand,” she says. “It was awful. Professional advice ranged from ‘wait and see’ to residential treatment, and neither option felt like the right one for us.”

Eventually, she was relieved when she was referred to a practice providing family-based treatment (FBT) for anorexia. “When I found FBT I just knew that was what we needed,” she says. “Our therapist helped us get our arms around the disorder and treat our child with respect and firmness. It made a world of difference, and she started to get better faster than I thought was possible.”

Erin’s experience with FBT is what every parent who has a child with an eating disorder wishes for: efficient recovery at home. And while FBT isn’t a fit for every child who has an eating disorder, it has been very effective for a subset of families facing anorexia in particular.

Eating disorder recovery

Approximately 13% of adolescents will develop an eating disorder by the age of 20. Eating disorders have been reported to be the third-most common chronic condition among adolescents. Despite this, research into the best treatment for eating disorders has been chronically underfunded. Therefore, evidence-based treatment trials for adolescents with anorexia nervosa are few, and study sizes tend to be small. As a result, many parents facing an eating disorder feel isolated and frustrated with the system of care.

Because it is one of the few anorexia treatments with scientific validation, FBT is considered by some to be the first-line treatment for adolescents with anorexia. There is also some evidence for its use with adolescents with bulimia.  In this article, I’ll review:

  • The evidence for FBT for eating disorders
  • How FBT can be used to treat eating disorders
  • What you should know if you’re thinking about FBT for your child’s eating disorder

What is FBT?

Family-based treatment (FBT) is also sometimes known as the Maudsley method or Maudsley approach. It is considered by some to be the “gold standard” treatment of choice for adolescents with anorexia. FBT is a manualized outpatient therapy designed to restore adolescents to health with the support of their parents.

Who does FBT work best for?

Family-based treatment (FBT) is an effective intervention for some adolescents with anorexia nervosa. Also, preliminary evidence suggests that it may be efficacious in treating adolescents with bulimia nervosa.

Qualified therapists use FBT with all sorts of eating disorder populations. So far, eight scientific studies have evaluated FBT in 657 patients with anorexia. And while it has been tested in multiple demographics, the majority of scientific evidence so far indicates positive outcomes for people who fit these criteria:

  • Adolescents <18
  • Female
  • Anorexia
  • Illness duration <3 years
  • Medically stable and fit for outpatient treatment

FBT has also been evaluated for bulimia. Three randomized controlled studies have evaluated 295 patients. These studies have indicated positive outcomes compared to individual therapy, though the results are less dramatic than those for anorexia.

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How to provide Family-Based Treatment

Many parents will cobble together an FBT-like treatment for their child with an eating disorder. However, true FBT is a detailed program based on a manual. Therefore, it contains specific elements in an outpatient setting and requires sessions with a trained therapist. Studies have evaluated short-term FBT (10 sessions over 6 months) and long-term FBT (20 sessions over 12 months). These have found no significant difference between the two approaches.

The first session typically includes a family meal. During this the therapist can observe the child’s eating patterns and family behaviors. At each session, the therapist will weigh the person who has an eating disorder. Following that, they meet with the family to discuss progress. These meetings may begin on a weekly schedule and decrease over time. 

The central premise of FBT is that families can be central to eating disorder recovery. And while it does not work for every family, many find it very helpful.

FBT is designed to replace inpatient treatment for an eating disorder. Meals at home are the priority, similar to how they form the foundation of inpatient treatment. This enables the person with the eating disorder to continue attending school and participating in activities as long as they are eating enough.

Principles of FBT

Family-based treatment for eating disorders is organized around a few basic principles:

1. Agnostic view of the illness

FBT makes no assumptions about the cause of the illness. Previously, families were blamed for eating disorders. To counteract this, FBT takes a strong position that families are not to blame. Rather, FBT focuses entirely on resolving the primary symptom of not eating. FBT is not concerned with identifying the underlying factors. Instead, it aims to get adolescents to stop using their eating disorder behaviors.

2. Externalize the illness from the patient

FBT emphasizes that the eating disorder and the child are not one and the same. The idea is that the eating disorder has “taken over” the child and is driving their thoughts, feelings, and behaviors. Parents are asked not to blame their child or believe that the eating disorder is the child’s choice. The goal of externalizing the illness is to reduce parental criticism, which has been shown to harm treatment outcomes.

3. The therapist takes a nonauthoritarian stance

The role of the FBT therapist is to take an active role in guiding the family through the recovery process. However, an FBT therapist does not tell the family exactly how to go about helping their child recover. The therapist partners with the family to help them figure out how best to refeed their child. The therapist models an uncritical, supportive, and compassionate stance toward the patient. Meanwhile, they take a firm, zero-tolerance approach toward eating disorder behaviors. 

4. Parents are empowered

In FBT, parents are empowered as the best resource for their child’s recovery. Essentially, they are seen as the main agents of change in their child’s therapeutic process. Therefore, FBT success rests in the parents’ confidence that they can handle the eating disorder. The therapist works to put the parents in charge and communicate confidence in their ability to beat the eating disorder.

5. Unwavering focus

FBT has a pragmatic, unwavering focus on symptom reduction. It is designed to quickly and single-mindedly focus on weight gain. Or, in the case of bulimia, ending binging and purging. Therefore, problems associated with the eating disorder like depression, anxiety, irritability, body image issues, trauma, loneliness, and more are not addressed in the first phase of FBT. The belief is that many of these secondary problems will lessen with the return to physical health.

What are the three phases of family-based treatment?

The FBT treatment for anorexia consists of three phases.

Phase 1

Phase 1 focuses on rapid weight gain. In cases of bulimia, the focus is on ending binge and purge behaviors. Parents are told that the disorder makes it hard for the child to make healthy decisions about food and eating. They are empowered to take over decisions about eating, much as would be done in inpatient care. Parents are responsible for deciding what their child eats, when, and how much is eaten. They typically also curtail any physical activity, much as would take place in residential treatment.

In the first or second session of FBT, the therapist will coordinate a family meal. During this meal, they will instruct the family on how to be more effective with the eating disorder. The goal of this meal is to give parents the confidence that they can encourage their child to eat more than they intended.

Phase 1 continues until the following conditions are met:

  • Steady weight gain
  • Eating disorder symptoms have begun to recede
  • The child is eating without significant resistance

Phase 2

During the second phase, parents will gradually give eating decisions back to the adolescent based on what is age-appropriate. This phase is introduced gradually and managed carefully.

Phase 3

During the third phase, the therapist reviews the adolescent’s progress and ensures the family is on track to get back to normal family life. The therapist offers skills to support ongoing development. Additionally, they will help the child navigate change without reverting to eating disorder behaviors to cope.

Is FBT right for your family?

Family-based treatment can be more effective than individual treatment for anorexia, especially in cases where it’s caught early. If you are considering FBT, it’s best to engage a qualified therapist who can follow the manualized process and guide your family through the steps.

However, if it’s not a good fit for you, you should know quickly. If that is the case, don’t hesitate to try other treatment options. It’s not a failure on your part, it just means FBT is not the right treatment for your family. Please don’t listen to anyone who says that FBT is 100% effective for everyone. It’s not. There are alternatives, and you should not feel ashamed if FBT is not the right fit for you.

What do parents say about FBT?

When it is a good fit, FBT is very effective, and parents rave about it. Parents who succeed with FBT say recovery is faster and more effective than alternative treatments. But even parents who found FBT efficacious say it is time-consuming and emotionally challenging. Implementing Phase 1 of FBT can be a full-time job for parents. Therefore, in some families, one partner will take a leave of absence from work to administer the treatment.

The risk of parental burnout with FBT is high. Burnout is a major risk for any parent who has a child with an eating disorder. Also, it’s serious because parental burnout has negative consequences for eating disorder treatment outcomes, whatever the modality. Therefore, parents report that having a qualified therapist and support community makes the job easier. Additionally, parent coaching can help prevent burnout.

That’s what Erin found helpful. “We had a great therapist, and I was active on parent message boards,” she says. “But I found that parent coaching was the real game-changer for me personally. Having a coach helped me work on my side of the equation and learn better communication skills. It made me much more influential over the eating disorder.”


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Mental health checklist for eating disorder recovery (free download)

Mental health checklist for eating disorder recovery

If your child has an eating disorder, recovery means more than simply gaining weight and/or stopping eating disorder behaviors; it means becoming mentally healthy. Eating disorders are frequently misunderstood, and people don’t always realize that mental health, not just eating disorder recovery, is the goal. 

That’s why I’ve put together a mental health checklist to help you set expectations and goals as your child recovers from their eating disorder. This mental health checklist is especially important if your child is returning to college or independent living after undergoing recovery in your home and/or a treatment facility.

Eating disorders are often layered on top of poor mental health and other mental disorders, so if parents don’t pay attention to mental health overall, they risk having a boomerang effect of having a child leave and return to treatment. While you can’t control their recovery, you can do your best to set your child up for success. Nobody wants your child to feel they are ready to return to independent living or go to college only to discover that they are not yet equipped to care for themselves, so the more you can help them build the skills they need to be mentally healthy, the better. A mental health checklist to be used during and after eating disorder recovery can help.

How to measure mental health

Mental health sometimes feels arbitrary. But in fact, we can measure mental health based on the behaviors that lead to and indicate mental health. It’s just like eating disorders. Except for medically-underweight anorexia, eating disorders don’t often have measurable physical symptoms. Instead, they are diagnosed based on the behaviors observed. 

For example, eating disorders are measured by how often a person eats, how much they eat, and how they feel about eating. Similarly, mental health can be measured by how well a person takes care of themselves and how they feel about themselves.

In addition to your child’s recovery process, they should be learning to take care of their physical health, which includes at a minimum: 

  • Getting adequate food and water
  • Moving their body appropriately
  • Getting enough sleep
  • Basic hygiene

Beyond basic physical healthcare, your child should also take care of their emotional health, which includes at a minimum: 

  • Connecting with others
  • Managing social media use
  • Practicing mindfulness
  • Getting outdoors
  • Asking for help
  • Taking breaks
  • Having self-compassion

Physical self-care after an eating disorder

Even if your child is cleared of an active eating disorder diagnosis, they are still at risk of mental illness. They will need to care for their bodies and minds intentionally for life. This is important for every person, but particularly for someone who has/had an eating disorder. Here are the basic physical care steps that your child should take to improve mental health. 

Getting adequate food and water

All bodies need enough food and water to function. And a lack of food and water has a significant impact on both mental and physical health. When someone has/had an eating disorder, it’s an indication that they may need to be more vigilant than others about caring for this most basic element of self-care. As your child transitions to living independently from you, they should demonstrate an ability to feed themselves adequate quantities of food every 3-4 hours and drink at least 6-8 glasses of water daily. 

Moving their body appropriately

Our bodies are made to move. Regular movement is essential to both physical and mental health. The tricky part is that many people who have eating disorders incorporate excessive exercise and/or are at risk of serious health complications if they exercise. However, as your child recovers from their eating disorder, they should work in regular movement to maintain health. This can be functional like having a walking commute to work or school, going for a short walk each day, doing a brief home exercise routine, or joining a gym or attending fitness classes. Your child should demonstrate an ability to move their body regularly, not too much and not too little.

Getting enough sleep

Getting enough sleep is a cornerstone of mental health. Your child needs 8-9 hours of sleep per night. People with eating disorders and other behavioral and mental health problems often experience sleep loss. Your child may have insomnia or struggle to settle down and get to sleep. While it’s easy to dismiss sleep as unimportant, it is as important as food, water, and movement to the human body and mental health. Sleep loss is no joke for anyone, but it is particularly risky for someone who has been diagnosed with a mental disorder like an eating disorder. Losing sleep is a major risk for someone with a history of mental disorders. Therefore, your child should demonstrate an ability to get adequate sleep each night and wake up at an appropriate hour in the morning. 

Basic hygiene

While basic hygiene may seem like a given, it can be a major struggle for someone with an eating disorder, anxiety, depression, or other mental disorder. On the one hand, if your child has OCD, they may lead towards overdoing hygiene. Some people will wash and clean themselves excessively. On the other hand, someone who is depressed or has ADHD may feel unable to clean themselves adequately. Either way, taking care of basic hygiene is essential to mental health. Like exercise, you’ll need to measure whether your child’s challenge is doing too much or too little and work from there. Set some basic expectations, like flossing and brushing teeth twice daily. Bathing can vary per person, but discuss the maximum number of days between showers and/or the maximum number of showers per day. Your child should demonstrate an ability to take care of their basic hygiene. 

Emotional self-care after an eating disorder

An eating disorder is a mental illness. This means that while physical symptoms and/or behaviors are used to diagnose an eating disorder, it is emotional and mental in nature. This means that your child needs to care for their emotional health. This is important for everyone, but particularly for someone who has/had an eating disorder. Here are the basic emotional self-care steps that your child should take to maintain their mental health. 

Connecting with others

Human connection is as important as food, water, sleep, and movement. It is a sign of mental health to reach out to other people. It doesn’t have to be lengthy or intense. Still, you should feel confident that your child has some human connection daily. It might be a phone call to a loved one, but it could also be as simple as going in person to get groceries or food and speaking to someone while getting it instead of ordering contactless delivery. 

Managing social media use

Social media can be a major impediment to mental health for numerous reasons. It is particularly dangerous for people who have/had eating disorders due to the algorithmic preference for very thin people who promote “healthy lifestyles” that include eating disorder behaviors and beliefs. While zero social media use might be ideal for mental health, it’s not realistic or necessary for most people. Your child should demonstrate that they can set limits on their usage. 

Practicing mindfulness

One of the symptoms of an eating disorder is a disconnection between the mind and the body. It’s as if the brain-body connection is severed. To recover and maintain mental health, your child needs to practice a mindful connection between the brain and body. Your child should have a daily mindfulness practice that actively connects the brain and body.

Getting outdoors

Studies have shown that being in nature, even for a few minutes daily, has numerous physical benefits, including less pain and lower diastolic blood pressure. It improves mood and reduces the risk of mental illness. Support your child in getting outdoors for at least a few minutes daily. They can combine this with either exercise or mindfulness, or both. They should take a few moments to feel the air in their lungs and look at the sky, a tree, or anything natural and not human-made.

Asking for help

There is a tendency when someone has a mental disorder like an eating disorder, anxiety, depression, etc., to self-isolate. They reach out less to people who care about them and say less about how they are feeling. You want to support your child in reaching out for help when they feel sad, scared, or angry. Nobody can take their feelings away, but sharing our feelings with other people is soothing and improves mental health. 

Taking breaks

The brain-body disconnection common in eating disorders often translates to ignoring signs of mental or physical fatigue. A mentally healthy person recognizes when they need a break and takes breaks to improve their health and performance. Help your child learn to take breaks when they are overwhelmed or having physical or mental symptoms of fatigue.

Having self-compassion

A mentally healthy person has compassion for themselves. They don’t beat themselves up when they make mistakes and don’t speak cruelly or dismissively to themselves. They know how to soothe themselves when things go wrong and treat themselves as they would a good friend. Help your child learn to speak to themself with self-compassion and love.

Giving your child a mental health checklist for eating disorder recovery

Discussing mental health with your child while they are still recovering from an eating disorder and preparing to leave your daily care will help them build mental health. You can create your own checklist or use the one I created. The checklist I created includes both daily actions and warning signs to keep in mind. You can provide this to your child and talk with them regularly about both elements: are they doing daily self-care, and are there any warning signs to address? This can help you communicate your concern for their mental health, even if your child isn’t living with you.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Emotion coaching when your child has an eating disorder

Emotion coaching when your child has an eating disorder

Emotion coaching is a 5-step method developed for parents by John Gottman, PhD that can be applied to eating disorder recovery. The emotion coaching method builds emotional intelligence and creates positive, long-lasting effects for children, from toddlers to teens and young adults. It’s evidence-based, easy to learn, and regularly used by parents, educators, therapists, and caregivers in many different settings.

When parents learn the emotion coaching method, they identify how best to respond when a child is sad, angry, scared, or emotionally dysregulated and having big emotions. Once parents understand emotion coaching, they recognize that emotions, even the big, scary ones, are opportunities to build connection and emotional resilience. 

Parents also learn that emotion coaching doesn’t let the child “off the hook” when they have big emotions, but rather that the child gets to have big emotions, and the parent also gets to set clear, consistent limits on behavior.

The five steps of emotion coaching are: 

  1. Be aware of your child’s emotions
  2. Recognize your child’s expression of emotions as a perfect moment for intimacy and teaching
  3. Listen with empathy and validate your child’s feelings
  4. Help your child learn to label their emotions with words
  5. Set limits and problem-solve
emotional regulation

Emotional literacy is critical in eating disorder recovery

Often eating disorder behaviors are a way for a person to cope with difficult and uncomfortable emotions. Thus, eating disorder recovery necessarily involves learning how to feel big and uncomfortable emotions without using eating disorder behaviors. 

This is why parental emotion coaching is so helpful for recovery. You are spending far more time with your child and seeing a greater range of emotions than their therapist. Therefore, if you can help your child learn to tolerate and process difficult emotions, you can help them recover from their eating disorder

But tolerating and processing emotions is not something that most of us do naturally. In fact, many parents do the exact opposite. For many parents, when a child has uncomfortable emotions, the goal is to settle the emotions and move on as quickly as possible. 

Here are the three most common techniques parents use to settle emotions quickly:

  • Accommodating: Your child is afraid of heights, so you avoid heights
  • Authoritarian: Your child gets angry when you ask them to take out the trash, and you yell back that they are ungrateful and need just to do the job without complaint
  • Reassurance/Facts: Your child doesn’t want to do something, so you provide them with facts and reassurance that it’s a good thing to do and that everything will be OK

These are just three ways that parents try to avoid emotions. Most parents who do this believe they are making the only rational choice. They believe that the rational way to handle emotions is to settle and/or avoid them. However, we know that the opposite is true. Repressed and avoided emotions tend to get bigger and more disruptive over time, not smaller. 

That’s why emotional regulation is a core element of eating disorder recovery. To recover from an eating disorder, your child must cope with big and disruptive emotions without their eating disorder behaviors. The only way to do this is to build emotional resilience, which can be achieved with emotion coaching. 

Emotion coaching when parenting a child with an eating disorder

Parents can support recovery by working with their kids’ emotions rather than denying, avoiding, or accommodating them.

1. Be aware of your child’s emotions

The first step in providing emotion coaching for a child who has an eating disorder is to recognize when your child is having emotions. This may seem obvious, but it is both essential and easy to miss. 

You need to tune into your child’s emotional state to do this. Consider these questions: 

  1. Do you know when your child is angry, sad, scared, or feeling another emotion?
  2. If so, how do you know? What are the signs of the different emotions your child feels? (hint: don’t focus on words alone. Emotional expression is much deeper than language, so look for physical signs like eyes, facial expression, posture, vocal tone, gestures, etc.)
  3. Do you understand that often there is a presenting emotion (e.g., anger, stubbornness) that is covering a primary emotion like fear, worry, and shame?

It helps to build your emotional literacy, or ability to recognize and label emotions. There are several tools to help identify feelings: 

Print out one of these tools and use it to help you recognize your child’s different emotional states. Look for opportunities to use more emotional language with your child. Show your child how often we have more than one emotion at the same time. For example, it’s normal to feel both nervous and excited at the same time. We may also have a presenting feeling like anger that’s hiding a core feeling like sadness. 

2. Recognize your child’s expression of emotion as a perfect moment for intimacy and teaching 

Most parents become alarmed and maybe defensive when a child has big emotions. But emotions are a perfectly natural and normal part of being human. There are a few different theories, but a common one developed by Paul Ekman, suggests we have six basic emotions. They are: 

  • Sadness
  • Happiness
  • Fear
  • Anger
  • Surprise 
  • Disgust

If you consider that there is also a state of neutral emotion, it’s safe to assume that most humans spend less time being happy than they do the many other emotions. Having a child who is not always happy is not a problem: it’s normal.

Uncomfortable emotions like sadness and anger are natural and normal. And your child needs you most when they are sad, angry, afraid, or experiencing other “negative” emotions. It’s not that your child needs to stop having the emotion. It’s that they need to have it safely, ideally with you until they learn to handle it by themselves without their eating disorder behaviors.

When your child has big emotions in your presence, it’s best if you acknowledge the emotions and see them as an opportunity to build your connection with your child. Don’t push the feelings away or avoid them, but rather to step into your role as an emotional caregiver and soothe your child’s emotions.

Soothing does not occur when you accommodate, make demands, bribe, or convince your child not to have their emotions. It takes place when you acknowledge their feelings and respond to them. Soothing can be both verbal and physical. For example, you can begin with labeling the feelings, but you can also start by reaching out to them, hugging them, and giving them gentle eye contact to let them know you are there with them in their pain.

When parents soothe their kids’ emotions, kids learn over time to soothe themselves. And this is the true growth opportunity of emotion coaching and why it’s so important in eating disorder recovery. When you coach your child, they learn to do it for themselves.

3. Listen with empathy and validate your child’s feelings 

Emotion coaching is a highly attuned, challenging task. Parents who want to emotion coach their kids through eating disorder recovery need to practice listening and validating. Here are some tips for this: 

Listening

  • Make sure you are listening to understand, not listening to respond.
  • Relax your desire to give solutions or convince your child of anything.
  • Breathe deeply and calmly while you listen to your child. 
  • Remain emotionally regulated.
  • Mindfully “listen” to your child’s body language, not just their words.

Validating

  • Mirror what your child said by repeating a few of their words or summarizing what you heard without judging, editorializing, problem-solving, or debating the “facts.” Say things like “It sounds like …” and “Let me know if I’m understanding how you feel, you’re …”
  • Say things like “I get it” and “that makes sense.”
  • Don’t discount feelings, tell them how they should feel, use logic, or try to fix anything.
  • Attend to your body language: have soft eyes, a relaxed but firm posture, and an engaged and open facial expression.
  • Avoid “why” questions, which will put your child on the defensive. 

Read more about validating a child with an eating disorder

You need to validate your child’s emotions, not their behaviors. There’s a big difference. For example, you don’t need to say, “I can understand why you didn’t eat today.” Instead, say, “It sounds like you felt overwhelmed by everything you had to do today (and didn’t eat).”

4. Help your child learn to label their emotions with words 

Consistently work with your child to label their emotions with words. This powerful way to integrate the mind is essential to mental health. Use the feelings tools from earlier and keep steering conversations with your child towards feelings. 

You can ask questions like: 

  • Tell me more
  • What was/is that like for you?
  • What did that make you think? 
  • How did/does that make you feel? 
  • How did/does that affect you? 
  • What did/does that mean to you?

When your child gives you an answer, try to pick out the feeling words or add some of your own to make sure the conversation is emotion-focused.

Most of us want to focus on “facts” and details. But with emotion coaching, you’re working to help your child identify their feelings, which will help them deal with distress without their eating disorder behaviors in the long term.

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5. Set limits and problem solve 

Emotion coaching is not permissive. In other words, while you are validating and accepting all of your child’s emotions, that does not mean that all behaviors are acceptable. 

For example, your child with an eating disorder might prefer to eat alone in their room. You can validate that they prefer to do that, but in your home, you insist on eating at the table as a family. Just because your child has feelings does not mean feelings should dictate behavior. This is very important when a child is dealing with dangerous behaviors like restricting, binge eating, and purging.

You can set clear boundaries and expectations that may include things like: 

  • Family meals
  • Not going in the bathroom after eating
  • Therapy appointments
  • No swearing at people or calling people names
  • Not hitting things or people

When things get hard, you can validate the feelings for why your child doesn’t want to or can’t meet the boundary but still uphold the boundary you have set. This is what parents learn to do in the highly effective and evidence-based SPACE Training

If your child has expressed their emotions and feels validated, you may move into problem-solving. But be careful about problem-solving, as most adolescents and young adults do not actually want you to problem-solve. Most of the time they want to express themselves and then solve their problems by themselves. 

Surprisingly, the more room you give your adolescent/young adult to solve their own problems, the more likely they will seek your advice. So hold back unless it’s specifically requested.

If you are sure that your child really wants you to problem-solve with them, here are the steps: 

  1. Identify goals
    • What is the problem we are trying to fix? 
  1. Think of possible solutions 
    • Brainstorm – no idea is too silly or stupid to consider 
    • Write them all down 
    • Remind your adolescent/young adult of past success and how he/she handled it 
  1. Evaluate proposed solutions based on family values 
    • Is the solution fair? 
    • Will it work? 
    • Is it safe? 
    • How am I likely to feel? 
    • How will other people feel? 
  1. Help your adolescent/young adult choose a solution if they want help doing so.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Childhood eating disorders: rates, risks, and treatment

Childhood eating disorders: rates, risks, and treatment

Childhood eating disorders have become a major concern, and parents are understandably panicked when their child needs to be hospitalized and begin treatment for these life-threatening mental disorders. Anorexia is now the third most common chronic illness among adolescents. Eating and feeding disturbances affect about 19.8% of kids ages 11-17 and often begin earlier.

We are facing increased rates of childhood eating disorders. Hospitalization rates for eating disorders doubled in 2020 compared to the prior two years. For comparison, previous studies showed that eating disorder related hospitalizations increased by 18% from 1999 to 2005. And hospital stays for eating disorders now last about 50% longer than before, suggesting more severe eating disorders. Meanwhile, there was no difference in outpatient visits or hospitalizations for other mental health conditions. This suggests that eating disorders are unique in their increase.

If you are facing childhood eating disorders, you’re not alone. Here’s some information about childhood eating disorders to help you navigate this tricky chapter of your life.

Types of eating disorders in childhood

Binge eating disorder: the most common type of eating disorder. It involves periods of restriction followed by periods of binge eating. Most people only look for the binge eating part. But it’s important to look carefully for the restriction that often precedes it, as it is an essential part of the cycle and should be addressed during treatment.

Bulimia nervosa: the second-most common type of eating disorder. Bulimia nervosa involves periods of restriction followed by binge eating and purging. Purging behaviors may include vomiting, laxatives, overexercise, and other attempts to expel calories consumed. As with binge eating disorder, there is a danger in only worrying about the binge-purge cycle without attending to the restrictive cycle.

Anorexia nervosa: the deadliest eating disorder. Anorexia nervosa involves periods of restriction. This may involve cutting out entire food groups like sugars, carbs, meats, and fats. It often involves skipping meals and eating tiny meals, extreme food rules, and fears that worsen over time. Most assume anorexia has a physical look (emaciation). However, someone can meet all the criteria for anorexia, including physical symptoms like low heart rate, and not meet the minimum BMI criteria.

Avoidant/restrictive food intake disorder (ARFID): the earliest-onset childhood eating disorder. ARFID involves a lack of interest in eating, extremely picky eating, and food avoidance due to reasons other than weight loss. A major indicator is a constantly-shrinking list of safe foods and increasingly limited food flexibility.

What are common eating disorder risk factors?

Weight orientation: Most people who have eating disorders have a weight preoccupation. Our society is weight-focused, so this is a risk factor for almost every child. Children who have parents who worry about their kids’ weight are at higher risk of eating disorders.

Chaotic and/or rigid eating: People with eating disorders may be very chaotic in their eating habits, which means not eating regular meals, sneaking food, and eating larger or smaller quantities than would be considered normal. They may also have rigid rules dictating which food is acceptable and cut out foods.

Dieting: Teens who diet are up to 18x more likely to develop an eating disorder, and the most common precursor to an eating disorder is starting a new diet or “healthy lifestyle.”

Body image: Kids who are worried about their body image are more likely to develop an eating disorder.

Over-exercise: A sudden increase in exercise, including rigid exercise schedules and a need to constantly move to burn calories is a risk factor and a symptom of eating disorders.

Family history: Having another family member with an eating disorder is a risk factor for eating disorders. Additionally, family member mental illness, including anxiety, depression, and substance use disorders, can indicate a genetic predisposition to eating disorders.

High anxiety: Children with high anxiety, poor distress tolerance, and low emotional regulation are at higher risk of eating disorders.

ADHD/ASD: There is a strong correlation between ADHD and ASD and eating disorders.

LGBTQ+: Children who identify themselves as or suspect they may be LGBTQ+ are at higher risk of eating disorders.

Health conditions: Health conditions requiring dietary control like diabetes, cystic fibrosis, inflammatory bowel disease, and celiac disease put a child at higher risk of eating disorders. 

Vegetarianism: People who are vegetarian are more likely to have eating disorders.

Certain sports: some sports have been highly associated with eating disorders, including swimming, gymnastics, and running. 

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What parents should do about childhood eating disorders

It’s understandable if the list of risk factors is alarming to you. Many children are at risk of eating disorders, and they are not rare. However, prevention is possible, eating disorders are not a life sentence, and effective treatments are available. The earlier they are caught, the greater chance of recovery. 

If you want to prevent eating disorders: 

Not all eating disorders are preventable. However, many are. Given the massive increase in eating disorders over a short period, we cannot blame eating disorders on genetics alone. Therefore, here are the things parents can do to prevent eating disorders in their homes.

  1. Don’t diet or control your weight.
  2. Don’t focus on weight as a standard of health, and teach children that low weight is not a requirement for health, success, beauty, etc. 
  3. Don’t allow dangerous behaviors like cutting out food groups (e.g., carbs, grains, meat, sugar, etc.), dieting, skipping meals, over-exercising, and spending excessive time in the bathroom, particularly after eating. Talk about these behaviors and set limits to secure your child’s safety. Don’t worry that talking about things will make it worse. Address problematic behaviors quickly and consistently.
  4. Practice emotional literacy and emotional regulation. Eating disorder behaviors help people cope with their emotional states, so training your child to have good emotional regulation is a major protective factor. 
  5. Have at least one family meal per day. Family meals are protective against eating disorders.

If you suspect an early eating disorder: 

  1. Take your child for a physical exam and check weight, heart rate, and other vital signs. This is not the only way to find early eating disorders, but it is an essential step. 
  2. Seek individual therapy and/or family therapy to discuss disordered eating and treat other mental health conditions like anxiety, ADHD, ASD, etc.
  3. Do not allow dietary changes like low-carb or vegetarianism or new, intense exercise programs. 
  4. Work on family connection and belonging. Positive family dynamics always improve mental health, so create more opportunities to strengthen your relationships.
emotional regulation

If your child has been diagnosed with an eating disorder: 

  1. Get treatment for your child as soon as an eating disorder is diagnosed. This may include hospitalization, residential treatment, or outpatient programs. Your child should see a doctor, therapist, nutritionist, and possibly a psychiatrist, especially if there are other psychological conditions like anxiety, depression, ADHD, ASD, etc.
  2. Get support and education for yourself. Find a coach, therapist, or support group to help you learn about eating disorders. You’ll need to change your behavior to create a pro-recovery household. You may also need to implement feeding programs like Family Based Therapy (FBT). It is very hard to do these things without guidance and support. You want to make sure that you are making significant changes alongside your child. 
  3. Increase emotional validation. A child facing a mental health crisis needs increased emotional validation. You are not validating the behaviors, but you are validating their feelings. Get some support and guidance for increasing your skills in this area. 
  4. Have clear and consistent boundaries. A major issue for parents facing a child’s mental health condition is that it’s very hard to set and hold clear boundaries. This is because the child is so distressed that it can feel cruel to hold them to expectations. However, boundaries are an essential part of recovery. Your child needs to know that you are strong enough to hold boundaries even when they are in distress. Also, you need boundaries for the sake of your own mental health. It will help nobody if you exhaust yourself in attempting to help your child. Parental burnout is a major risk factor for ongoing mental health problems, so your own care must also be a priority.

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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A log parents can use to track eating disorder symptoms and treatment

Keep a log of eating disorder symptoms and treatment

If your child has an eating disorder, then it may help you to keep a log of eating disorder symptoms and treatment. This is a useful tool to support you in seeking treatment, recognizing progress, and, when necessary, making decisions to switch to new or different treatment. A mental health log can help parents keep track of their kids’ mental health and support them in making strategic decisions to support recovery. 

There are many benefits to keeping a mental health log of eating disorder behaviors and treatment. The three most important reasons are so you can: 

  • Maintain your focus and know what’s working and what’s not working
  • Share your notes with treatment providers to keep treatment on-track
  • Recognize when things are getting better or worse

An eating disorder is a constantly moving target, and getting from day to day can be a major undertaking. But if you don’t have a tool to pull yourself up from the weeds and see the big picture, you can’t make strategic decisions. And impulsive decisions based on your feelings alone are often much less effective than decisions that are made in a more strategic manner. A log that tracks eating disorder symptoms and treatment will help you keep everything straight.

Why keep an eating disorder treatment log?

Managing a child’s eating disorder is a big undertaking. There is so much information and many details to keep track of. Since you have other things on your plate and you’re more likely to forget details in stressful situations, it helps to write down what is going on. Doing this will help you keep track of medications, rules, and expectations so that you aren’t wasting time trying to remember what was said or tracking down different pieces of paper, medication bottles, and other things to help jog your memory. 

In times of stress, it can be dangerous to rely on memory, since facts become distorted with pressure and time. Keeping a detailed log of eating disorder symptoms and treatment means you have the information you need at your fingertips.

What is an eating disorder tracking log?

A log for eating disorder symptoms and treatment can help parents keep track of all the little and big things that take place during the various stages of having an eating disorder. Whether your child is in a very active eating disorder or in early, mid, or full recovery from an eating disorder, a log can be helpful. 

An eating disorder symptom log should track the following:

  • Eating: for example, what and when did you serve food, and what was eaten. You may also include how it was eaten (e.g. easily, slowly, fast, reluctantly, etc.)
  • Other behaviors: for example, track whether your child is purging and, if so, how often. Same with over-exercise. You can also observe whether body image issues are becoming more or less frequent. 
  • Conversations you have with professionals: this should include notes from your meetings with therapists, doctors, dietitians, etc. This should include information about the treatment they recommend and suggest and why you did or did not follow it.
  • Distressing events: you should take note of major events such as self-harming, anxiety attacks, and aggressive behavior. Describe what happened and approximately how long it lasted and its intensity.
  • Conversations with important adults: note things that people like coaches, teachers, family members, etc. have said to you about your child’s behavior. Sometimes it’s hard for us to see what’s going on, and these comments, when written down, give us insight.
  • Appointment notes: if your child is being monitored by a medical doctor you can keep track of vital signs like weight, heart rate, etc. Also, take note of any recommendations and suggestions. If you chose not to follow the doctor’s advice, state why.
  • Medications recommended and/or prescribed: keep track of what was prescribed, when, why, by whom, and at what dosage. Also track when providers adjust medication or if they make a recommendation that you disagreed with. Note any positive impact of medication and possible side effects.

In addition, you should have a quick-reference sheet showing you the providers’ names and phone numbers and any medications your child is on. 

How to keep a quality log

You already have a lot on your plate. A parent who has a child with an eating disorder is facing tremendous work in terms of treatment and care. You’re already doing the planning, scheduling, coordinating, budgeting, and decision-making. This is a lot of work. 

So you don’t have to turn keeping a mental health log into another tedious job for yourself. But you should have a system for jotting down your notes at the end of every day. As things improve, you can reduce this to every other day, then once per week, and so on. Remember that eating disorders can be effectively treated and you probably won’t have to do this forever. But it will be a tremendous help to you if you keep track of what’s going on. Aside from anything else, a good mental health log will give you the peace of mind that you are on top of your child’s care. 

log eating disorder symptoms

What format to use

Start by thinking through the format you will use for your log.

Some people really like paper and a pen for keeping notes. If so, get yourself a dedicated notebook and a pen and put them in a place where your child will not find them. Unless you are approaching the log as a group effort, you might want to hide it so your child cannot stumble across it. For some kids, a treatment and symptom log will bring on feelings of being vulnerable, observed, and exposed. 

If you prefer a digital record, then you have several options. You can set up a spreadsheet or a document, or even just use your note-taking app on your smartphone. Whatever you use, keep in mind privacy concerns, and password-protect your devices so your child doesn’t accidentally see your log if you don’t want them to. 

Once you know whether you’re going paper or digital, consider a standardized format. Not everyone likes this, but many people find it helpful to have a list of what they should be logging. To help, I’ve created a document with everything you need to get started. 

log eating disorder symptoms

Getting in the habit

In the beginning, make it a habit to jot down a few notes every day. New habits are hard to start, but once you get going, they get easier. Here are some tips for starting a new habit: 

  1. Get ready: gather the supplies you need and set up your worksheet, cheat sheet, or whatever you’re using to keep your log
  2. Set a goal: it’s very hard to build a habit if your goal is undefined. Commit to daily notes or, if that’s not possible, a note every time you do something like visiting the pediatrician or dietitian. 
  3. Set up a cue: if your goal is to make a note every day, set up the specific time and location. Many people will set a reminder on their smartphones to make sure this happens. Another option is to make the cue something like when your child goes to their therapy session, after dinner, or something else that reliably happens.
  4. Set up a reward: it’s best if you feel successful when you complete your habit each day. This could be something simple like giving yourself a quick hand or temple massage, scrolling through your phone for 5 minutes, or getting a hug from your partner. 
  5. Have a plan B: while you really want to stick to a regular plan to create a habit, it can be helpful to build in your plan B. This is what you will do if you don’t meet your goal. For example, can you set a second reminder on your phone? If you forget to do it after dinner, can you do it before you go to bed? Establish this in advance so it feels like a more formal and thus acceptable backup plan.

The log is not a journal for your feelings

Journaling your feelings about the eating disorder might be very helpful for you. A journal can help you process your difficult emotions and thoughts about your child’s disorder. However, this mental health log is not the same thing as a journal. I suggest you keep the two concepts separate. Remember that a good log might be helpful for you to show to your child’s treatment providers. So you want to limit your personal thoughts and feelings.

Keep the log factual, and process your feelings elsewhere. Use a reporting approach: stick to the facts! You can even use a reporter’s prompts to structure your notes: 

  • What happened?
  • Where did it happen?
  • How did it happen?
  • Who was involved?
  • Why did it happen?

Privacy considerations

Your child’s private health information is sacred. I already mentioned this, but carefully consider whether you plan to share your log with your kid. And, if not, make sure they have no way to accidentally stumble upon it. I really can’t overstate this. What you are doing is not wrong. However, it could be hurtful for your child to discover your log without adequate preparation. Here are a few options for thinking about how you set this up: 

Keeping an open log

You may choose to make the log open and accessible to your child. This means you share with them that you are keeping the log and are willing to show it to them upon request. However, it does not mean your child is keeping the log for themselves. If their therapist suggests they journal or maintain their own notes, that’s separate from what you are doing. Even if you are providing your child with access to the log, make sure that it is your responsibility to record your observations and notes. 

Keeping a private log

A more common approach is to keep a private log. In this case, you keep your log private and in a secure location that your child cannot access. You are gathering very personal information, so it is essential that you take this very seriously. There are ways in which an eating disorder symptoms log can go awry, including: 

  • The child with the eating disorder finds it and feels criticized, triggering a relapse or new symptoms
  • Siblings find the log and make fun of the child or become worried about the child’s health
  • Other people, from nosy neighbors to extended family members find the log and catastrophize the situation, possibly even accusing you of wrongdoing if they don’t understand what’s going on

This is why it cannot be overstated: if you keep a handwritten log, make sure that it is hidden securely in a place that nobody will find. If you keep your log on digital devices, make sure they are password-protected to make sure nobody can access them except for you. Don’t fall into the trap of relying on weak passwords that your children are likely to guess! Do not use anyone’s birthday, name, or classic combinations like 12345, abcdef, or the all-too-common mistake of using the word “password” as your password.🤣

Get started!

Keeping a mental health log of eating disorder symptoms and treatment can really help you uncover patterns of behavior. It will also help you recall facts and information that you’ve received in the past and jog your memory about why you have made the decisions you have made. Finally, it can be very helpful when you’re talking to new treatment providers who need a history of what has taken place so far.

You can get started here


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Parental burnout and eating disorders

Parental burnout and eating disorders

If your child has an eating disorder, then there’s a good chance you’re dealing with parental burnout. This describes a parent who is mentally and physically depleted. This depletion can lead you to feel like you are failing at parenting, and, unfortunately, parental burnout is associated with worse behavior from kids. This creates an unfortunate loop of the parent being burned out, the kids behaving badly, and the parent getting even more burned out, and on and on. 

There are many reasons to address parental burnout when there’s an eating disorder, but the three most important reasons are: 

  1. Parents who have burnout deserve care and support – they are no less important than their kids.
  2. Parents who are burned out are less able to support their child through recovery.
  3. Kids whose parents are burned out sense there is a problem and may act out more, making things even harder.

An eating disorder is a major family crisis, and a depleted parent will be less effective at getting through to the other side. But burnout is not your fault. It’s a failure in the systems that should be supporting you. I’m so sorry this is happening. I hate that we don’t have better systems of care so that you don’t have to be burned out. But this is where things stand today: if you have a child with an eating disorder, you are probably burned out.

So I’ll give you some ideas for what you can do to help yourself recover from parental burnout. But first, let’s get started with more about what parental burnout is and its impact on family life. I’m afraid that if you don’t fully understand the consequences of burnout you won’t get the care you need to succeed.

What is parental burnout?

Feeling stressed while parenting is normal and expected. But parental burnout goes beyond expected levels of fatigue and means that you are exhausted and overwhelmed. When you are burned out, you struggle to function. 

When you become burned out, your ability to respond to both everyday and high-level stressors is reduced. Parents who are burned out feel physically and emotionally unable to connect with their kids, which can, unfortunately, lead to even more struggles with parenting. 

A 2021 study conducted by researchers at Ohio State University found that parental burnout has reached dangerously high levels since the Covid-19 pandemic began, particularly for working parents. The study found that: 

  • 66% of parents report feeling burned out
  • Women are more likely to feel burned out than men
  • Parental burnout is increased in households with 2-3 children, plateaued with 4-5 children, and increased again with 6 or more children
  • 77% of parents who had a child with ADHD and 73% of parents who had a child with anxiety reported parental burnout
  • 72% of parents who were concerned that their child could have an undiagnosed mental health condition reported burnout

Basically, burnout is common and responsive to how many kids you have and whether your kids have mental disorders.

parental burnout workbook

What is the impact of parental burnout on kids?

Parental burnout can make it feel impossible to drag yourself through the day and you may feel like a failure in every aspect of your life. I’m so sorry about that. Unfortunately, parental burnout also impacts kids, which typically means they get even harder to manage than before. This can feel like an impossible situation, but don’t worry: I’m going to give you some solutions soon! 

Parental burnout is strongly correlated with depression, anxiety, and increased alcohol and substance use in the parent. Parents who are burned out are more likely to insult, scream at, criticize, and spank kids. All of these factors have significant negative impacts on kids’ behavior. In other words, when parents do these things, kids get even harder to handle, leading to even more burnout. It’s a vicious cycle.

Kids whose parents are burned out are more likely to exhibit attention issues, internalizing behaviors, and externalizing behaviors. Here’s what this looks like:  

Attention behaviors:

  • Fidgety, unable to sit still
  • Daydreams or zones out too much
  • Has trouble concentrating
  • Is easily distracted

Internalizing behaviors:

  • Feels sad or unhappy
  • Is down on themselves
  • Worries a lot
  • Feels hopeless
  • Seems to be having less fun

Externalizing behaviors

  • Refuses to share and may take things that don’t belong to them
  • Does not understand other people’s feelings
  • Fights with other children
  • Blames others for their troubles
  • Teases others

Source: Journal of Pediatric Psychology

And while I don’t have direct data linking parental burnout to eating disorder behaviors, you probably recognize some of the above symptoms in your child. They are all signs of distress, and while there can be a lot of reasons that kids are distressed, having a parent who is burned out is a major stressor for any child.

parental burnout workbook

Why is parental burnout common when kids have an eating disorder?

It’s probably pretty obvious why parents who have a child with an eating disorder are at high risk of parental burnout. The constant stress of having a child with a major mental disorder is exhausting, and it can feel as if you have no options. The healthcare system does an inadequate job of helping parents who have kids with eating disorders cope. In fact, many times there is no support for parents or the advice is ignorant and even harmful. It’s rough. I’m so sorry. 

Based on the data available, we know that 72% of parents who worry their child has an undiagnosed mental health condition, 77% of parents who have a child with ADHD, and 73% of parents who have a child with anxiety report they are suffering from burnout. I think it’s safe to say that at the bare minimum 72% of parents who have kids with eating disorders have burnout, though I would guess it’s even higher based on my experience. 

And it’s no wonder. Our healthcare system is not structured to adequately and comprehensively care for people who have eating disorders and their families.

Recipe for parental burnout with an eating disorder

Burnout was initially recognized in the workplace. Here’s the recipe for burnout when you’re facing an eating disorder:

  • Lack of control: having a child with an eating disorder means you feel you are unable to influence their health, and you may lack the resources you need to parent effectively.

  • Unclear job expectations: you are likely unclear about the degree of authority you have or what your child who has an eating disorder, their treatment team, your other children, your spouse, and others expect from you. It’s unlikely you feel comfortable while parenting, which is stressful.

  • Dysfunctional dynamics: you may feel bullied by the eating disorder, micromanaged by your child’s anxiety, criticized by your other children, and undermined by your partner or spouse. This contributes to parenting stress.

  • Extreme activity: parenting with an eating disorder is typically chaotic. The constant demands placed on you, combined with the fear and anxiety about your child’s disorder demand intense energy in order for you to remain focused on the task at hand, which can lead to fatigue.

  • Lack of social support: most parents who have a child with an eating disorder feel isolated and unable to talk about what they are dealing with when talking to friends and family members. This lack of support leads to more stress.

  • Imbalance: parenting a child with a mental health condition takes up so much time and effort that it seems impossible to invest energy in your own needs and pursue activities that fill you up. As a result, you can easily feel depleted. 

How do you know if you have parental burnout when dealing with an eating disorder?

Many times you can sense that you are burned out. It’s completely fine to self-diagnose yourself. In general, be on the lookout for these symptoms of burnout: 

  • Irritability
  • Fatigue
  • Changes in sleep and/or appetite
  • Mood swings
  • Feeling like a failure
  • The sense that you are underwater
  • Complete overwhelm

What sets parental burnout apart from regular stress is that it negatively impacts daily functioning. Basically, you are less productive and effective and struggle to accomplish tasks that used to feel manageable.

What can you do if you are burned out from parenting a child with an eating disorder?

I know you have a lot going on with your child’s eating disorder. And while you need to continue the work of helping your child recover, you also need to care for yourself. As you know, when parents are burned out, kids do worse, not better. So if your lifestyle right now is leading you to burnout, then it’s essential that you get the support you need and deserve to feel better. Recovering from burnout takes effort, which is cruel since the primary symptom of burnout is the lack of energy to do anything. But you need to invest in yourself to recover from burnout. The consequences of not recovering are serious, so please reach out for help! 

Recovering from burnout is not unlike recovering from an eating disorder. It is essential to your health and wellness, and when you are burned out, everyone suffers. So this is not optional or selfish. You need to recover from burnout to operate effectively as a parent. Here are some ideas: 

1. Do less

It’s time to “Marie Kondo” your life. You probably have a lot on your plate right now. And there are a lot of things that were previously enjoyable and wonderful that may not be bringing you joy right now. Look at your life critically and decide what you can stop doing. This is urgent. Can you stop driving the kids to school? Maybe your child can unload the dishwasher so you can stop doing it. Can your neighbor walk your dog? List as many things as possible that you can stop doing, and stop doing them immediately. This can be temporary for as long as you’re dealing with the eating disorder, but don’t skimp on this step, as it is essential! You cannot reduce burnout if you don’t reduce what’s on your plate.

2. Non-negotiable self-care

No matter how busy you are, you have to prioritize non-negotiable self-care. Seriously. You don’t have the option of not taking care of yourself, because taking care of yourself is essential to taking care of your child who has an eating disorder. Sleep at least 7 hours per night. Move your body for at least 10 minutes per day. Drink 6-8 glasses of water. Feed yourself at least every 3-4 hours. And, most importantly, connect physically and/or emotionally with someone for 10 minutes per day. This could be asking your partner to cuddle with you on the couch (just make sure you aren’t doing anything else like scrolling through your phone). It could be calling a friend to talk about a TV plot line or crying about how hard your day was. If you can’t fit these essential self-care steps into your life, then go back to step 1 and figure out what you need to stop doing.

3. Take breaks

Even a 5-10 minute break a few times per day will help. During these mini-breaks, listen to your body. What feels right? Consider staring into space, guided meditation, stretching, drinking a cold glass of water or a hot cup of tea, walking around the block, or maybe dancing to Rage Against the Machine or the Mama Mia soundtrack. Do whatever feels good to you at the moment – make sure it is something that only benefits you! It doesn’t count as a break if you’re doing it for someone else.

ad-parentcoaching-ed

4. Give yourself more love

Most of us are really mean to ourselves, and it often gets worse when we are burned out. We would never speak to our friends the way we criticize and berate ourselves. Start talking to yourself as if you are your best friend. Be kind, thoughtful, and understanding when things aren’t working out for you. Practice self-compassion. Research shows that people who practice self-compassion perform at much higher levels than those who do not. But even if there were no productivity benefits, being nice to yourself is the right thing to do!

5. Talk about it

Stay connected to family and friends, and pick at least one person to whom you can talk about the eating disorder. Shame thrives in secrecy, so bring it out of the shadows and talk about your experience with the eating disorder. It can be tricky to figure out the boundaries here, but a good rule of thumb is that you get to tell your story of the eating disorder, but not your child’s story of the eating disorder (because that’s theirs). It may be helpful to tell your friend in advance whether you’re looking for advice or just a compassionate ear. Hint: most of the time you’ll just want them to listen.

6. Ask for help

I know it’s hard, but you need to expand your help networks. Ask for help with meals, childcare, driving, and everything else you are struggling to fit into your day. Reach out to family and friends, neighbors, and online communities. We are social creatures, and we’re not supposed to handle life alone. Think of how good it feels when a good friend asks you for help, and remember that when we ask for help our friends usually feel honored and will help if they can. When you’re burned out you tend to get tunnel vision, and you believe that you have to personally do everything. This is a cognitive distortion. Reach out and get the help your community can give you.

7. Get professional support

Dealing with an eating disorder is not a small undertaking. Most of our care systems focus almost entirely on the person who has the eating disorder, but that leaves parents in the dark and they become prime candidates for burnout. Find a coach or therapist who can work with you to help you understand the eating disorder, your role, and how you can help your child recover. You don’t have to (and you shouldn’t) do this alone!

If you are suffering from parental burnout while your child has an eating disorder, it makes perfect sense. Please get the support and resources you need to start feeling better!

parental burnout workbook

Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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How to handle the Fourth of July with an eating disorder

How to handle the Fourth of July with an eating disorder

Jamie is worried. Her 13-year-old daughter Kayley has an eating disorder, and their annual family reunion for the Fourth of July is around the corner. This event is typically a highlight of their year. Filled with family and friends, four generations, and lots and lots of food. 

“I just can’t imagine how we are possibly going to do this holiday with Kayley’s eating disorder,” says Jamie. “How are we going to feed her, and what will I do when my mom inevitably comments on Kayley’s weight? It’s going to be a disaster if I can’t figure out how to handle this.” 

Jamie is not alone. Lots of parents have to decide whether to attend Fourth of July events and, if they do, how to make it as safe and fun as possible for everyone.

Check with your treatment team

The first thing to do is check with your child’s treatment team. Of course this event is a big deal for you and your family. But an eating disorder occurs on a huge spectrum from manageable to medically dangerous. Depending on where your child is on that spectrum right now, you may need to make the difficult choice to skip this year’s reunion. 

I know this is devastating, and I’m sure you would rather not. But please keep in mind that if your child is medically compromised by their eating disorder, then you are essentially in a similar position as someone who has a child who is in chemotherapy and is immuno compromised. While technically they can go to a family reunion, their doctor may suggest skipping it this year to maintain optimum conditions for recovery. 

If this is the case for you, I’m sorry. But an eating disorder doesn’t have to be forever, so hopefully this is a one-year change of plans with long-term benefits. 

Plan for feeding and eating 

Depending on your child’s eating disorder and stage of recovery, you may expect them to maintain a rigid meal plan, or you may agree to be more flexible during the event. Either way can work for a medically stable person who has an eating disorder, but make sure the decision is made up front and not in response to the conditions at hand. 

You’ve been to this event before so you know approximately what will happen. Is eating typically chaotic and random? Or is it formal and pre-planned? Given this information, plan how you will maintain your child’s need to eat regular, full meals every day. If you can fit in with the way your family operates every Fourth of July, that’s great! It would be wonderful if your child can join everyone else in eating. If not, maybe you can work in a few stable meals between group activities. Or you can plan to feed your child completely separately. 

You have a lot of choices. Don’t let them take you by surprise once the event is underway. Make them in advance and then stick to the plan when you’re there.

Check with your child

Next you need to talk to your child about the event. I wouldn’t put the decision of whether to go or not in your child’s hands. I know this is tempting, and our cultural norm is to empower kids to make their own decisions. But in this case, giving your child the power to decide whether your family will attend a reunion is too much pressure, especially if they have an eating disorder, which means anxiety is high. 

Instead, approach your child thoughtfully with the fact that you will go to the reunion this year, and then set your expectations in terms of the feeding and eating plan that you established. While you do want your child’s engagement in planning for the event, they should not feel they bear the responsiblity of keeping their care on-track. That should be yours to handle.

Also talk about how stress can trigger anxiety and eating disorder behaviors and have a plan in place for dealing with that. Mainly, you want to give your child permission to have feelings and be uncomfortable sometimes. It’s going to happen, so don’t turn something natural into a shameful event. Instead, set up expectations for how your child will recognize and respond to their feelings of anxiety and urges to engage in eating disorder behavior. 

This is not a one-and-done conversation. It is multiple conversations that should take place before and during the event.

Identify the “problem” family members

Every family has its combination of easy-going and more problematic family members. Take some time to think through who will be there and any potential disasters. For example, is your uncle Harry a known dieter who loves to share how many calories he’s restricting himself to and then names how many calories are on everyone else’s plate? Is your sister Jenny doing Whole 30 or Intermittent Fasting? Does Grandma tend to talk about people gaining and losing weight?

Make a list of the family members who may say things that will negatively impact your child’s eating disorder recovery and consider how to handle them.

Depending on your relationship with them, here is what I recommend: 

  1. Make a quick phone call or send a text telling them that your family is dealing with some body image issues and you hope they understand that it would be best if they didn’t mention dieting, weight loss, or weight gain. You do not have to tell them about the eating disorder unless you want to. A boundary does not require full disclosure or understanding to be valid or effective. 
  2. If they are offended by this, then you know to steer clear (and steer your child clear) of them during the reunion. It’s OK to prioritize your child’s health over being around people who refuse to respect your boundaries and requests.
  3. If they say “no problem,” then stay near your child and monitor conversations. Most people don’t even realize they are talking about dieting and weight loss when they do it because it’s such an integral part of their socialization. But just because no harm is intended does not mean it’s OK. You can change the subject, ask them to stop, or simply leave the conversation. 
  4. Talk to your child regularly throughout the event to find out if anyone has said anything upsetting. If they have, you don’t have to storm off and make a big deal about it. It’s in the past. But you can talk to your child about what happened and help them process it. Most of the time we don’t have to force other people to change in order to help our child feel better.
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Stick to your plan

One thing that often happens at family reunions is that we get distracted by activities, people, and the chaos of being together. This is a lovely part of seeing people we know and love. But you do need a bit of extra dillgence this year to account for the eating disorder. 

For example, you may be tempted to relax the meal plan because it’s too complicated or feels too disruptive. Or maybe someone questions your decisions or makes you feel bad about doing things differently this year. But if you’ve committed to a meal plan before the event, avoid changing it due to circumstances. While flexibility is wonderful, it should not be applied to feeding when there’s an eating disorder.

Similarly, you may wish you could ignore relatives who say things that trigger your child’s eating disorder because you just want to relax and have a good time. That makes a lot of sense, but your child needs to know you’re paying attention and keeping them in mind even when it’s inconvenient. 

The basic advice for handling a big event like a Fourth of July party during an eating disorder is to make a plan, talk about the plan, and stick to the plan. Don’t avoid doing this even (especially) when it’s hard. Your strong efforts this year will pay off for years to come.

Jamie’s 4th of July

Jamie thought carefully about her family reunion in light of the eating disorder. Kayley’s care team said it was safe for her to go away for the four-day weekend, and Jamie planned out the meal structure and talked to a few problematic relatives. It was stressful for Jamie to talk to her mom especially. 

“I know how much she loves Kayley, and the last thing I want to do is make her feel bad,” says Jamie. “But I knew it was important, not just this year, but forever. Now that we’ve faced an eating disorder, things have to change. We can’t act like nothing has happened, and I can’t let diet and weight talk seep into our lives again. Of course people are going to do what they’re going to do, but I can at least set expectations.” 

And while Jamie’s mom assured her that she would not say anything, in the chaos of the reunion a few things did slip out. But Jamie gently redirected the conversations and it was actually helpful, she said. “My mom has never heard of the body positive movement, and she really hasn’t thought about how toxic it is to talk about other people’s weight. I feel like this gave us a good opportunity to talk about that. She was surprisingly open and curious, which was really helpful.” 

For privacy, names and identifying details have been changed in this article.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Sending your child to summer camp with an eating disorder

Sending your child to summer camp with an eating disorder

Summer camp is a great opportunity for your child who has/had an eating disorder to feel a sense of belonging, community, and independence. And since these things are essential to mental health, summer camp can be a great prescription for moving forward and embracing recovery. Here are six things to consider if you’re thinking about sending your child with an eating disorder to summer camp.

1. Medical stuff first

Before your child can go to camp, they need to be cleared medically and psychologically. This doesn’t necessarily mean they need to be 100% free of their eating disorder, but they should, at a minimum, not be medically underweight or have active complications like low heart rate, blood pressure, etc. 

Talk to your child’s doctor, therapist, and dietitian and get their opinion. Will the challenge of summer camp be a positive experience, or is it too risky? It’s really helpful for kids who have eating disorders to be with peers and to feel connection and belonging, and summer camp is a great place for that. It’s also a great place to try their healthy coping skills and stretch their independence. So be sure to ask your providers to consider the benefits as they make their recommendation.

Now, check your gut: do you think your child is stable? This is an intuitive choice you need to make, so read the rest of this article and then spend some time sitting with your options. 

Finally, consider which duration is best for your child. This may not be the year for a month-long camp, but perhaps a week or two weeks would work. Consider the duration based on your intuition of how stable your child’s recovery is right now.

2. Monitoring for trouble

Ideally your child should be stable enough in their recovery and you have chosen a duration that makes sense based on where they are in recovery. Those are important considerations, since I suggest you avoid making too many special accommodations during their time at camp. 

You may ask the camp nurse to weigh your child mid-way through a 2-week camp session if you believe that is necessary. You may also ask the camp staff if they can monitor whether multiple meals are skipped and alert you to that. 

But if you are asking for a lot more than that to accommodate your child’s eating disorder, it may be a sign that this is not the right year to do summer camp. The camp cannot step in and take the place of yourself or your child’s treatment team. If your child needs more support for their eating disorder, then it may not be the right time for summer camp.

3. Sending special food and other accommodations

Summer camps are structured and have a lot of rules. Those rules are there for a reason. In some ways, they are there to make the camp counselors’ jobs easier. But in a lot of ways those rules mirror social expectations and norms. Rules are a natural and essential part of belonging to a group.

If you find yourself making special requests for your child because of their anxiety and eating disorder, then pause. Look out for your desire to accommodate your child and consider if it’s serving recovery or maintaining the disorder.

I suggest that as much as possible you set the expectation that your child is a normal camper. They should eat the same food, have the same sleeping arrangements, do the same activities, and have the same communication standards as other campers. That, after all, is the point of camp. They are all in the same place at the same time, living under the same rules and expectations. That’s how camps build a sense of belonging. And belonging is exactly what your child needs to embrace recovery.

Avoid sending them to camp with a special diet or sewing a secret cell phone into their pillowcase for emergencies. The point of camp is that every camper is the same – that’s the beauty of it, and that’s where your child will gain the benefit of belonging and community. If you treat them differently, they will not get those benefits.

Finally, do not make an agreement in advance that you will pick them up early if they get uncomfortable. You need to set the expectation that they will stay the whole time. Don’t send them if you don’t believe they can make it. An anxious child will naturally feel anxious at camp sometimes. They will naturally reach for an “out” if it’s there and ask you to come and get them. Make sure you haven’t set up the expectation that they should call you to remove them from camp at the first hint of discomfort. Getting through discomfort is one of the benefits of summer camp.

4. Dealing with their worry

The most important thing about summer camp is to expect your child to be worried. Your child will feel worried and anxious about leaving home, about being in a different environment, and about meeting other people. Help them understand that worry is a normal part of trying new things, but that we don’t let worry make important decisions for us. The goal is for them to feel worried and do it anyway. That’s a key skill to emotional regulation and mental health, so don’t miss the opportunity to talk to them about it.

Don’t try to answer every question, instead, help them learn to tolerate the uncertainty of doing something different. Think of this as an emotional training camp. They will learn to handle worry, and they’ll probably have a great time while doing it.

Finally, avoid automatically jumping in to solve problems that are your child’s problems to solve. For example, if they are worried about making friends, don’t tell them how to make friends. They know how to make friends! They are just worried. And it’s OK to be worried. Help them feel their worry and solve their own problems rather than jumping in to solve their problems for them. That’s not the path to independence or emotional health.

5. Dealing with your worry

You are going to be worried. Your child is going to summer camp and they have/had an eating disorder. Expect your worry to show up, and deal with it with other adults, not your child. Look for your own anxiety and seek support from people you trust. 

If you tend to get worried, then be careful about the daily photo dumps that often come from camps. These photo dumps can send parents into a tailspin of worry. Desperately trying to find your child in the crowd and then carefully evaluating their facial expression and those on the faces around them can ruin your whole day. Review the photos (if you care to) when your child gets home. I’m certain you picked a safe camp. You don’t need to monitor your child’s safety through photographs!

Finally, be open to everything being fine. You will have worry, and your child will have worry, but that doesn’t mean they won’t have a great time at summer camp. They may surprise you … I hope they surprise you! Let them!

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6. Communicating while they’re there

The camp should have clear rules about communication between campers and parents. Like all camp rules, these are structured on purpose to build belonging among the campers as well as independence for your camper. If you violate these rules, you risk the greatest benefits of going to camp. 

First, don’t call the camp every day to check on your child. They will call you if there’s a problem!

Next, don’t set up special communication with your child. Remember that the rules and norms are there for a reason, and you should follow them. I’m a big fan of camps that have a zero cell phone policy and don’t have campers call home mid-week. Let your child find the freedom, joy, and uncertainty of not reaching for their phone every 5 minutes to check in.

Finally, don’t panic if your child tells you they don’t like something. It’s normal not to like stuff! If your child complains about something, wait at least 24 hours before trying to resolve a possible problem. Wait as long as you can. Unless the camp calls you, then it’s probably fine. We’re talking about one week, not months. Each day at camp is different, and a miserable camper on Day 1 could easily be a happy camper on Day 3. Hang in there and trust the process.

The goal of camp

The goal of summer camp is to help your child build belonging and connection with peers as well as personal autonomy and independence, all of which will support eating disorder recovery. You want them to navigate the world as a healthy child who can tolerate being a little uncomfortable, grumpy, unshowered, and sunburned sometimes. That’s normal life! Camp doesn’t have to be perfect to be great!

That said, if everything I’ve said has made you very nervous, then maybe wait this year out and try again next year when you’re both feeling more stable.

Interesting article: Now Is the Time to Reboot Summer Camp


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Eating disorders in children: symptoms, evaluations & treatments

Eating disorders in children: symptoms, evaluations & treatments

Eating disorders are a serious problem, and children are not immune to their symptoms and complications. 9% of the U.S. population, or 28.8 million Americans, will have an eating disorder in their lifetime, and most begin in childhood or adolescence. The number of children with eating disorders has increased significantly since 2000. One study found that hospital admissions among adolescents with eating disorders more than doubled during the first year of the COVID-19 pandemic. Furthermore, eating disorders and their symptoms now occur in more children under 12 than before.

There are many reasons why an eating disorder arises in childhood. First, there are hereditable and genetic components to eating disorder development. But that genetic predisposition does not explain the massive rise in eating disorders in recent decades since our genes don’t change that quickly. 

Environmental factors play a significant role in eating disorder development. One of the biggest culprits is weight stigma. 42% of 1st-3rd grade girls want to be thinner, and 81% of 10-year-old children are afraid of being fat. This societal fear of weight gain shapes a child’s psychology around eating and growth and can easily disrupt a healthy relationship with food and the body.

Then there are psychological and family influences. For example, stress and anxiety are frequently associated with eating disorder onset, meaning a major disruption like COVID-19 naturally increased rates of eating disorders, which can become a powerful coping mechanism. How parents and families respond to eating disorder behaviors can influence treatment outcomes.

What are the common symptoms of eating disorders in children?

Eating disorders have many symptoms. Most people think that an eating disorder has a “look.” But only 6% of people diagnosed with an eating disorder are medically “underweight.” Most eating disorders are not physically obvious, and the behaviors may easily fly under the radar since we live in a culture in which dieting and food restriction are considered normal.

Here are some signs that a child has an eating disorder

  • A sudden interest in calories, ingredients, fat content, carbs, and other nutritional data
  • Eating too fast or too slow
  • Secret eating or lying about eating
  • Significant weight changes that cannot be explained by natural growth
  • Over-exercise
  • Frequently checking body weight and appearance
  • Mood disruptions and mood swings 
  • Skipping meals
  • Significant changes in clothing, makeup, and appearance
  • Friendship disruptions and losses
  • A negative change in school performance
  • Behavior that is either more aggressive or withdrawn than before

Quiz: does my child have an eating disorder?

Eating disorder symptoms in kids

Eating disorders and their symptoms in children can be hard to spot, particularly if they appear in early puberty and adolescence. These are times of major body changes, and weight gain and loss can happen naturally in developmental cycles. 

This is why weight is only rarely a useful measurement of an eating disorder. Paying attention to your child’s relationship with food, weight, and exercise will give you the best indication of whether your child is struggling with disordered eating or an eating disorder. 

Early and comprehensive intervention is best, so don’t hesitate to consult with an eating disorder-trained registered dietitian if you are concerned.

Except in extreme cases in which weight is clearly below the standard weight trends on a BMI chart, weight can be an imperfect measure of an eating disorder. Parents should pay attention to other symptoms, including the child’s relationship with food, their weight and appearance, and how much they are exercising. 

Relationship with food: 

  • Has your child suddenly cut out meals, certain foods, or entire food categories? For example, are they skipping breakfast and lunch, no longer eating ice cream, which they loved before, becoming a vegetarian, or cutting out carbs? 
  • Does your child seem uncomfortable with food? Are they playing with their food at the table, avoiding eating it? Or are they eating very quickly and don’t appear to be savoring their food like they used to? Have they stopped eating with your family, preferring to eat alone?
  • Has your son started using dietary supplements and protein shakes? Sometimes parents miss this sign of eating disorders in boys, who may be interested in becoming both leaner and more muscular.

Relationship with weight and body image: 

  • Has your child suddenly started weighing themselves regularly? Do they seem obsessed with the number on the scale? You won’t know this if the scale is in the bathroom. Get rid of all scales in your home and see what happens. There’s no upside to having a bathroom scale since it perpetuates harmful weight stigma and eating disorder behaviors.
  • Does your child check their body in the mirror more than before? Are they pinching their flesh questioningly or disgustedly?
  • Has your child started asking you repetitive questions about their weight and appearance?
  • Is your child wearing very baggy, loose clothing to hide their shape? 

Relationship with exercise:

  • Has your child recently joined a sport like cross country running or other sports where participants tend to be very lean?
  • Is your child exercising daily when they used to exercise little or not at all?
  • If you go on vacation, is your child insistent that they must be able to exercise while you are away? 
  • Is your child exercising constantly, always wanting to be moving? Do they exercise secretly in their room?

Eating disorders in children: medical testing and diagnosis

A physical exam may include measuring weight and height and checking vital signs. Typically this includes: 

  • Heart rate
  • Blood pressure
  • Temperature
  • Heart and lung function

A doctor may also check skin, nails, and teeth for problems and conduct a general physical exam. Lab tests may be used to further evaluate health, including: 

  • Complete blood count (CBC)
  • Electrolytes
  • Protein
  • Liver, kidney, and thyroid function
  • Urinalysis

X-rays may be done to check bone density, assess for fractures or broken bones, and check for pneumonia or heart problems. Occasionally an electrocardiogram will look for heart irregularities.

Keep in mind that while Anorexia Nervosa does have a weight limit to aid diagnosis, the majority of eating disorders will not include low weight, medical complications, or any measurable physical signs. A doctor’s visit in which everything looks normal does not mean your child does not have an eating disorder. Eating disorders and their symptoms in children are a delicate subject that you want to approach thoughtfully and assertively.

Very few doctors have formal training in eating disorders. This means that while they can be useful in identifying and monitoring physical complications, they can rarely help with the behavioral symptoms of an eating disorder. If your child has medical complications as a result of their eating disorder then it’s best to find a physician who is a Certified Eating Disorder Specialist (CEDS) or is getting consultation from someone who is. 

One of the best professionals for eating disorder diagnosis and treatment is a registered dietitian who has the CEDS certification and/or formal training in eating disorders. They are trained and qualified to identify and treat the nutritional symptoms of an eating disorder and can typically direct you to other healthcare providers who can help.

Binge-type eating disorder symptoms 

Statistically, the most common eating disorder symptom is binge eating. This includes repeatedly eating a large quantity of food in a short period. Most people who binge eat report an altered state in which they feel numb or unaware of what they are doing. It is also important to know that most people who binge eat go through cycles of restriction first. If binge eating is part of your child’s diagnosis, make sure their treatment addresses food restriction first. Without changing the patterns of restriction, it’s unlikely that treatment for binge eating will be successful.

Restrictive-type eating disorder symptoms

Most eating disorders involve some form of restriction. This means your child intentionally avoids eating even when they are hungry or even starving. Most people who restrict feel strong and powerful when they overcome the physical sensation of hunger and skip a meal or eat less than they would have before the eating disorder. However, ARFID (Avoidant Restrictive Food Intake Disorder) is an eating disorder in which the person is not restricting for weight loss purposes but rather eats less due to sensory complications with food, eating, and digestion.

Purge-type eating disorder symptoms

Bulimia features purge behaviors, but all eating disorders may involve some form of purging. Common forms of purging include vomiting and laxative use. Most people who purge begin doing it to rid their bodies of food that they believe is “too much.” They believe they will gain weight if they don’t purge. However, over time, purging can become a powerful form of self-soothing, and it isn’t necessarily tied to weight loss. 

Exercise-based eating disorder symptoms

Many eating disorders involve some form of over-exercise. Most people begin a new exercise program to slim down and eliminate calories consumed. They believe that if they exercise enough every day, they will avoid weight gain and lose weight. Often exercise becomes compulsive, and it will be hard for your child to stop doing it for any reason. Some people with eating disorders will exercise in their bedrooms and in secret to achieve the fitness goals they have set for themselves.

Body image eating disorder symptoms

Most people who have eating disorders (except for ARFID) feel bad about their bodies. They believe their bodies don’t appear healthy or good and pursue weight loss and exercise programs to try and shape their body into what they believe they should look like. In girls, this typically means weight loss. In boys, it may look similar or involve a desire to be both lean and muscular.

Combined type symptoms

Most eating disorders evolve in children, so you often see a combination of symptoms. Bulimia is the most multi-faceted eating disorder, as it features all symptoms (though not always exercise). But even a person who has typical anorexia may sometimes binge eat or purge. During diagnosis, your child’s most pressing symptoms will be evaluated to develop the best label for treatment and insurance reimbursement.

Eating disorders in children: how a diagnosis is made

People who can diagnose an eating disorder include: 

  • Medical doctor
  • Registered dietitian
  • Psychotherapist 
  • Psychiatrist

It is best to find a professional who has received formal training in eating disorder diagnosis and treatment. Look for a Certified Eating Disorder Specialist (CEDS). One of the easiest and best ways to get a diagnosis for an eating disorder is by a Registered Dietitian who has the CEDS credential. They are more common and easier to access than a physician with that credential.

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Eating disorders in children: how treatment is prescribed

Treatment is prescribed based on the diagnosis, specific behaviors observed, and the severity of the health outcomes. Depending on the situation, your child may be recommended to one of the following treatment options: 

  • Hospitalization 
  • Residential treatment
  • Intensive outpatient treatment
  • Personal treatment team: doctor, RD, therapist, and psychiatrist if needed

I strongly recommend finding professionals who explicitly embrace a non-diet, Health at Every Size® (HAES®) approach. In my experience, weight-neutral care, in which the provider is not using weight as the most important indicator of health, is essential to full eating disorder recovery.

See our directory of HAES®-aligned providers

In almost all cases, parental and family engagement will vastly improve treatment outcomes. There is strong evidence for Family Based Treatment (FBT) when weight gain is necessary. Family therapy and parent coaching are very helpful in supporting parents who want to optimize their child’s chance of full recovery.

Eating disorder or disordered eating?

Many parents will wonder if their child truly has an eating disorder or disordered eating. This typically doesn’t happen with classic cases of anorexia which include weight criteria. All other eating disorders do not have weight criteria and therefore leave more room for debate. 

I encourage you not to worry about the exact diagnosis. Many people who have disordered eating will move on to a full-blown eating disorder, and even if they don’t, they can live their lives with a sub-clinical but severely life-limiting problem. 

The bottom line is that if your child’s eating behaviors, relationship with food, feelings about weight and their body, and the way they exercise are disordered, then you want to treat those problems quickly and assertively.

Full recovery and a healthy, full life are possible for your child.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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The risks of accommodating an eating disorder

The risks of accommodating an eating disorder

Rachel was at the end of her rope. After years of trying to help her daughter Lily claw her way out of anorexia, it simply wasn’t getting any better.

Sure, there was COVID to blame. The pandemic made Lily even more socially isolated, and online treatment didn’t seem to be as effective. But overall, Rachel knew that Lily’s problem pre-dated the pandemic. And she was worried that it would extend way beyond the pandemic if something didn’t change fast. 

“The truth is that I’m completely burned out,” says Rachel. “This is my last hope. If this doesn’t work, I really don’t know what I’ll do or how I’ll keep this up. Something’s got to give.” 

Rachel has decided to try a treatment program called SPACE that focuses on changing her own behavior rather than trying to change Lily’s behavior.

“It’s just been a brick wall to try and convince Lily to recover,” says Rachel. “I know I’m not supposed to say this, but she just isn’t choosing recovery. She’s not taking any steps on her own to get better.”

Rachel is struggling under the caregiving burden. “When she was younger, she was a bit more self-sufficient, and being at school motivated her,” says Rachel. “But now she’s done with school, and she’s doing almost nothing. She lives with me, and I try to feed her six times per day like I’m supposed to. She’s nowhere close to feeding herself, and I can’t see her being able to get a job or move out.”

Rachel, like so many parents and caregivers, is terrified for her daughter. She’s also frustrated and fed up. Her diligent, valiant work feels like a drop in the bucket. The eating disorder is powerful, and she’s losing hope.

What is accommodation?

When someone is afraid of something, they naturally want to avoid it. 

Parental accommodation is a way that parents make it easier for their children to avoid doing the things that scare them. 

If your child screams when they see a spider, you whisk it away quickly and then soothe your child, trying to calm them down as soon as possible. This accommodation makes perfect sense.

But the next day, your child asks you to check under their bed for spiders before going to sleep. This, too, makes sense to you. You accommodate their wishes – it’s not a big deal! 

But the next day, your child asks you to check that their windows are locked tightly and check under the bed, scan the walls, and peer into the darkest corners of the closet with a flashlight to ensure there are no spiders. 

The accommodation snowball effect

You can see where this is going. Your child’s fear of spiders makes sense. But their avoidance of possibly encountering a spider ever again is becoming a problem. Even though you sense it’s wrong, you can’t imagine not accommodating them because they get so upset just thinking about spiders. It seems faster and easier to do what they ask than to convince them to go to sleep without it.

Sometimes you try to talk your child out of it. You prepare deeply-researched and highly-rational arguments to persuade them that spiders aren’t scary or dangerous. Sometimes you lose your temper and yell that you aren’t their personal spider valet and you won’t do this tomorrow night … this is the last time! 

But, of course, the next night, your child cries and seems so terrified that you give in one more time and look in all the nooks and crannies. Later they come into your room at midnight, wake you up, and beg you to check again.

You’re half asleep, and it seems like less trouble to just look than to try and convince your child there are no spiders, so you grudgingly get up, stomping your feet and huffing as you walk to their room and look in all the corners for spiders. 

You’re feeling angry, but you can’t see a way out of accommodating your child’s avoidance of possibly seeing a spider. You feel trapped and frustrated, stuck in a web.

How does accommodating impact eating disorders?

I started with a spider story because it feels less charged than an eating disorder. Eating disorders are complex, multi-layered mental disorders. Also, parents are not responsible for either their child’s fear of spiders or their eating disorder. It typically doesn’t work that way.

But parents may be responsible for accommodating their child’s anxiety-driven eating disorder behaviors.

Parental accommodation is called a “maintaining factor” in eating disorders. This means that it is not the cause of an eating disorder. But accommodation can make it easier for an eating disorder to dig its heels in and stick around for the long haul.

Eating disorder accommodation examples

There are many ways parents accidentally accommodate eating disorder behaviors. Let’s break down how accommodating can sneak into some of the common eating disorder recovery goals:  

  • Goal: have the child eat regular, healthy meals.
  • Accommodation: the child cries and yells at the dinner table. The parent becomes so distressed that they excuse the child before the meal is finished.
  • Goal: cut down on ingredient checking and calorie counting
  • Accommodation: the child refuses to eat until they know exactly how many calories are in the yogurt. It just seems easier and faster to tell them.
  • Goal: have the child eat various foods, not a limited menu of “safe food.”
  • Accommodation: when serving meals, the parent doesn’t offer new foods. They know their child will throw a fit or simply refuse to eat. Sometimes they try to add something new to the plate, but it goes so badly that they rarely do this.
  • Goal: have the child eat comfortably with other people.
  • Accommodation: the child becomes so upset about the idea of multiple people at the dinner table that the parents feed the child separately. Or they excuse the child from family meals because they are so distressed.
  • Goal: for the child to accept their body and not worry about its appearance.
  • Accommodation: when the child asks if they look bad, the parent freezes and ignores the question. Then, when the child doesn’t stop, the parent says in a falsely cheerful voice, “you’re just being silly – of course you’re beautiful!”
  • Goal: the child attends scheduled meetings with professionals.
  • Accommodation: the child insists that the therapist is useless. The nutritionist makes them eat unhealthy food, and the doctor is fatphobic and clueless. The parent spends hours every week convincing the child to attend just one more meeting. They use bribes and rewards, which work only some of the time.

All of these parental responses make perfect sense. If you do these things, you are not bad! Occasional accommodations make sense. But it can be a problem if parents repeat the same accommodation at every meal and/or the list of accommodations keeps growing. We want to stop accommodating eating disorder behavior even though it’s really, really uncomfortable for both the parent and the child. 

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How can parents stop accommodating?

Parents can stop accommodating eating disorder behaviors, but it takes some careful thought, a solid strategy, and practice. It’s not a good idea to remove all your accommodations at once. A strategic, steady approach is best. 

First, you need to understand how you are accommodating the eating disorder behaviors and why you are accommodating. You will naturally think you are accommodating to avoid your child’s distress. But you are also accommodating to avoid your distress about your child’s distress. Make sense?

When your child yells and screams or slams their door in your face, you feel upset. You worry that your child will never get better. Of course you do!

This is what drives the accommodation. You want to avoid your child’s upsetting outburst, so you do whatever you can to avoid it. 

Start with you

Understanding your own worry is the first step to addressing and ending accommodation. Because ending accommodation is all about what you do. How your child responds must be relatively unimportant and not change your approach. 

You will take unilateral action to remove your accommodation lovingly and compassionately. And your child is going to be distressed. Both of you will be able to handle this distress. But you may need some support to prepare and get through it.

Next, you will pick a specific accommodation and make a detailed plan to stop doing it. You’ll tell your child what you’re going to do, why you’re doing it, and when you’ll begin doing it. 

Finally, you’ll follow through. You’ll stay steady even in the face of your child’s worry and anguish. This will be hard, but you know that continuing the accommodation, while possibly easier in the short term, will not help in the long term.

You’ll stay dedicated and single-minded in your commitment not to accommodate eating disorder behaviors anymore. Over time, your child will learn your boundaries. Your child will feel less anxious. You’ll interrupt the anxious cycle of an eating disorder and invite recovery to take root.

Rachel and Lily

Rachel was terrified of ending even her most minor accommodations. For example, she told Lily what was in her smoothie every day. This was happening even though it was exactly the same every day.

She made a plan and told Lily that she would not answer smoothie ingredient questions anymore. Lily asked a few times on the first day, and Rachel was near tears but held her boundary lovingly. 

The next day, Lily asked ten times and started to cry when Rachel held her compassionate boundary. She refused to drink her smoothie. Rachel worried that she was making a mistake or doing it wrong.

But on the third day, Lily asked Rachel once, then, shockingly, drank her smoothie. 

Progress!

“I nearly fell out of my chair,” says Rachel. “I couldn’t believe it didn’t keep getting worse.”

Lily asked about the smoothie ingredients every few days throughout the next few weeks. And if it was an especially stressful day, she asked several times in a row. But Rachel was confident that not reviewing the ingredients was the right thing to do to help Lily recover, so she held her boundary lovingly and firmly.

Over time, Rachel removed more and more accommodations. Some were easier than others, but she could see the benefits. Mealtimes were less stressful for Rachel, which meant she could better support Lily through the stress of eating. 

“I feel more hopeful today than I’ve felt in five years,” says Rachel. “This is the biggest improvement I’ve seen in a long time. I feel like I’m really getting the hang of not accommodating her eating disorder behaviors. I’m focusing on controlling myself rather than trying to control her.”


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

For privacy, names and identifying details have been changed in this article.

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Health myths you should ignore to prevent eating disorders

Myths you should ignore to prevent eating disorders

So many of our cultural health norms are not actually healthy, which is why I’ve put together a list of the four health myths you should ignore to prevent eating disorders.

Look, it’s not our fault that we’re confused about health. We’re surrounded by powerful industries that create and reinforce health myths. We have the diet industry, the food industry, and the fitness, beauty, and fashion industries. They are all motivated and skilled at making us believe they have the answer to being healthy. But while health does require the basics: food, housing, and food, consumer goods are not the path to health. Health is an inside job.

Raising healthy kids

Jon and Theresa always wanted the very best for their two kids. Theresa is a nurse and Jon runs marathons. Together, they thought they knew what to do to raise healthy kids. But now that their kids are tweens, they see signs of disordered eating.

“My first hint that something was wrong was when whole containers of peanut butter and loaves of bread would disappear,” says Theresa. “We don’t keep candy, cookies, or chips in the house, but when we went to parties I would see my kids hovering over the food table, grabbing every bit of junk food they could get their hands on. It was shocking to see them put away so much food so quickly. I tell them they will get stomachaches, but they don’t stop. It seems like they have a limitless capacity for junk food.”

Jon agreed. “At first I thought that meant we needed even stricter rules, but now I’m not so sure. It seems like maybe we’ve raised them in such a carefully-managed environment that they just go crazy when they’re out in the real world. I just don’t know how we can keep them healthy anymore – my rules don’t seem to be working very well.”

The relationship is what matters

Often parents worry so much about feeding kids a “junk-free” diet. But in doing so they don’t realize that their kids’ relationship with food and their body is what’s most important. And without a healthy relationship with food and their bodies, kids are susceptible to disordered eating and eating disorders.

Theresa and Jon are worried that their older daughter is developing binge eating disorder. “She’s eating a lot more than usual at night and then skipping breakfast and lunch almost every day,” says Jon. “Sometimes we catch her in the pantry at night, and she seems so desperate and unhappy. Last night she was sobbing in my arms about how much weight she is gaining. I told her she’s beautiful, but it didn’t help.”

“I realize that we have created a lot of food rules and restrictions in our house, and even though our goal was health, it’s not working out so well,” says Theresa. “We both grew up with SpaghettiOs, Pop-Tarts, Top Ramen, and frozen pizzas and burritos, and maybe being so strict with food as parents was an overcorrection.”

Theresa and Jon are not alone. We want to do everything we can to raise healthy kids, but sometimes common health advice gets in the way of them having a positive relationship with food and their body. Even though health myths are everywhere, parents can safely ignore most of them, especially if they want to prevent eating disorders. Health doesn’t have to be complicated. It’s not easy parenting in the midst of all these health myths. But we can do it!

Here are the four parenting myths you can ignore to prevent eating disorders:

Myth 1: my kids will never stop eating sugar and junk

There is a powerful myth in our culture that kids, and all people, are insatiably drawn to sugar and “junk” food. And while there is plenty of evidence that food companies strategically create food that appeals to our genetic predisposition to eating lots of life-giving calories, this doesn’t tell the full story.

Yes, our bodies are very attracted to sweet, salty, and fat-filled food. But bodies are not naturally insatiable unless they are experiencing restriction (famine). In fact, it’s becoming increasingly understood that eating an entire sleeve of Oreos is more likely based on the fact that you have negative beliefs about the Oreos and have told yourself not to eat them than the Oreos themselves. You read that right: restriction, not access to delicious food, breeds binge eating.

There are many people who raise kids using Intuitive Eating and/or Ellyn Satter’s Eating Competence method. With these eating styles, people feed themselves healthfully but don’t avoid foods(except for allergies), eat according to appetite, and don’t use weight as a measurement of success. These styles of eating have been associated with the highest levels of health across multiple domains, from cardiovascular to mental health. They are also protective against eating disorders.

Parents should serve kids regular meals featuring a variety of food. Meals should include starches, fats, vegetables/fruits, protein, and dairy (if there’s no lactose intolerance). To avoid binge eating or an unhealthy relationship with food, serve desserts and other tasty, highly palatable foods as part of your regular rotation. 

I know it’s hard to believe, but when you serve all the foods, you’ll raise kids who naturally modulate their food intake and don’t suffer from a scarcity mentality that drives binge eating and/or dieting and restriction. The best thing you can do for your child’s physical and mental health is to raise them to have a healthy relationship with food.

Myth 2: I need to lose weight to be healthy

We live in a culture that is cruel to bodies, so it’s not unusual for parents to be actively working to lose weight with diet and fitness programs. Or on the other hand, parents may feel so discouraged that they don’t feed their bodies well, move them enough, or otherwise treat them with kindness and respect. 

Disliking and tearing apart our bodies and trying to achieve health with weight loss is a cultural obsession that is linked to body dissatisfaction and eating disorders. Surprisingly, intentional weight loss is not associated with increased health and is associated with higher lifetime BMI

There are many myths linking weight loss to health, when in fact it is the most common precursor to weight gain and eating disorders.

Ask yourself: 

  • Am I actively trying to lose weight?
  • Would other people judge my exercise program as intense or extreme?
  • Do I think I need to lose weight?
  • Am I struggling with binge eating?
  • Would other people say that my eating is “pure,” “clean,” or otherwise admirable based on social media standards?
  • Am I avoiding events and celebrations because I feel ashamed of my body?
  • Before attending events and celebrations, do I try to lose weight so I look better?
  • Do I have bad body thoughts almost all day, every day?

One of the most important things we can do to prevent eating disorders is to heal our own relationship with food and our body. Our children listen when we groan and complain about our bellies, thighs, and other body parts. Our children are watching when we limit our dinner to a salad with no dressing. They know when our exercise is more compulsive than pleasurable.

It’s best if we can adopt a non-diet approach to health. This is not “letting ourselves go,” it is respecting our bodies. This includes eating healthfully (see what that means above), and movement, which is great for almost all bodies. But dieting to lose weight or adopting extreme fitness programs can have serious consequences for our own bodies and our kids.

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Myth 3: I need to manage my kid’s weight

The essential health behaviors we need to manage for our kids are:

  • Meals and snacks: serve a variety of foods regularly, reliably, and in a pleasant environment
  • Movement: provide access to free play, P.E., individual/team sports, and/or family physical activities like hiking or dancing together in the living room
  • Sleep: depending on their age, our kids need 8-12 hours of sleep. Sleep is essential for both mental and physical health and should be carefully managed.

But should parents “manage” kids’ weight? Should we monitor it and restrict their food and/or increase exercise if their weight increases or has always been higher than we’d like it to be?

The simple answer is clear: no. The idea that parents need to control kids’ weight is one of the most harmful myths contributing to eating disorders.

And I’m not coddling kids by saying this. The most common outcome of parents who restrict kids’ food with the goal of weight loss is actually higher lifetime weight. That’s right: attempts to control weight actually increase weight. Dieting and weight control in childhood and adolescence predict higher BMI in adulthood. This is because of a syndrome called weight-cycling.

Basically, when you intentionally lose weight, your body kicks in a bunch of biological systems to deal with the perceived famine. Your body has many non-conscious methods such as slowing your metabolism and extracting every single calorie from your diet to try and maintain homeostasis. It will do everything it can to get you back to the weight you were before, often with a little extra to keep you safe.

Restrictive diets and intentional weight loss are both strong predictors of an eating disorder.

It makes sense in our society that parents worry about kids’ weight. Nonetheless, parents should not try to manage or reduce kids’ weight. Focus on healthful feeding, enjoyable movement, and sleep, and trust your child’s body to settle into the weight it’s meant to be.

Myth 4: health is something I can see

Multi-billion dollar industries are dedicated to convincing us that health is visible. After all, if we believe that health is something we can see, we are more likely to buy the products that promise to make us look healthier. Gorgeous models are hired and Photoshopped to sell us the idea that beauty and thinness equal health. But it’s simply not true.

The myths saying we can see health by observing someone’s weight contribute to eating disorders. Health is an inside job. Heavier people are just as likely to be healthy as thinner people. People who are not gorgeous can be just as healthy as gorgeous people. So what can parents actually do to improve kids’ health? Raise your kids in a healthy environment by following these guidelines: 

  1. Don’t diet and don’t let kids diet (dieting is associated with weight gain and eating disorders)
  2. Feed kids healthfully (using Ellyn Satter’s Eating Competence model)
  3. Get kids moving for fun and function (with friends and with you)
  4. Protect kids’ sleep (meet the minimum age-based requirements)
  5. Build healthy emotional connections with your children (enjoy them and make family time meaningful and fun)
  6. Help kids learn to self-regulate their emotions (begin by co-regulating with them to build this skill)

These are the basic foundations of health. If you achieve these six things, your child has the structure and support they need to be healthy. And if problems arise, as they probably will, you’ll have the tools to help your child feel better soon.

Moving forward

Theresa and Jon are getting parent coaching to help them build a food- and body-friendly household for their kids. They’re working on being a lot more flexible with how they define health and developing new communication and emotional skills. They can see that certain health myths were increasing their kids’ risk of eating disorders.

Their daughter has responded well to their changes. She is eating more regular meals and experiencing fewer binge-eating episodes. There is less stress around food and she can comfortably eat a few cookies without feeling the urge to binge eat all of them and then restrict afterward to try and make up for it.

Last week they went to an annual family event that is known for its delicious and formerly forbidden foods. This year, Jon and Theresa noticed that their kids ate and enjoyed the food, but they also spent far more time with their cousins. They were not chained to the food table, but rather socialized and enjoyed themselves.

Both kids are more relaxed around food. It took a little bit of time, but now they are showing all the signs of being competent eaters. Eating is a lot more fun and less stressful for everyone. And Jon and Theresa feel more confident and secure that they are raising their kids in a truly healthy environment.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

For privacy, names and identifying details have been changed in this article.

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SMART goals parents can set in eating disorder recovery

SMART goals parents can set when kids return to college after an eating disorder

Vicky is feeling really nervous because her 19-year-old Alex (they/them) wants to go back to college after eating disorder treatment. Alex is highly motivated to get back to school and manage their own life, but Vicky feels deeply unsure about exactly how that will work. 

“I can’t get over the memory of having to hospitalize them and put them in inpatient treatment last year,” says Vicky. “It was traumatic for all of us, and right now I can’t even imagine feeling good enough to send them back to school even though they say that’s what’s motivating them to recover right now.”

Vicky struggles to balance being a responsible mom with the freedom Alex wants. She wants to get clear about what Alex needs to do to show her that they are ready to go back to college.

I suggested coming up with some goals that will help Vicky feel better about sending Alex so far away again. I recommend using SMART goals for eating disorder recovery, since they are specific and attainable, and there can be no doubt as to whether they are achieved. They’re also motivating because Alex will be able to see a pathway to freedom from parental oversight.

What are SMART goals? 

SMART goals are often used in business and education settings to help employees and students set and achieve measurable goals. The key to SMART goals is that they are very specific and work well when you have large goals that you want to break down into smaller steps. 

SMART is an acronym that stands for “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” Every SMART goal features these essential elements to ensure the goal can be reached to satisfy both the child who will take action towards the goal and the parent who wants to see the goal achieved.

Specific: What is the goal? 

The goal should be well-defined, clear, and unambiguous. For example, it’s not enough to say “eat enough.” If the goal is to eat, get specific, like “eat 3 meals and 2 snacks every day.”

Measurable: How will I measure progress?

The goal should have specific criteria that measure progress. For example, if the goal is 3 meals and 2 snacks daily, the child could text a photo of each to their parent or dietitian.

Attainable: Do I have the resources & skills for it? 

The goal should be something that is attainable and not impossible. It should be within the child’s capacity to do. In the eating example, the child needs access to food and a smartphone.

Relevant: Why is this goal important? 

The goal should be an important step toward self-management. It should matter to you and your child. In the eating example, maintaining regular meals and snacks is a major part of being a competent eater, and thus makes sense as a relevant goal.

Time-Bound: When will I achieve the goal I’ve set?

The goal should have a clearly defined timeline, including a start date and a target date. For example, if they send photos of all three meals and snacks every day for eight weeks, you may set a new SMART goal that gives them less oversight in the next stage.

Why are SMART goals important? 

SMART goals are important because they help parents:

  • Set clear intentions, not broad or vague goals
  • Feel confident about the child’s path to self-management
  • Focus on the specific behaviors that support recovery
  • Measure progress with specific benchmarks
  • Provide sensible objectives that are realistic and achievable
  • Avoid the distraction of a long list of goals that is hard to manage
  • Be clear about the timeline and next steps if goals are met

SMART goals increase your child’s pursuit of self-management by making your expectations really clear and unambiguous. Your college-age child wants to get out from under parental control, so setting SMART goals gives them a clear path to doing that. These goals communicate that you believe your child can succeed but also gives you the confidence to let them go away to college.

How can SMART goals help with eating disorder recovery?

SMART goals can help with eating disorder recovery, especially for college students, because they help both the child and the parents get what they need. The child wants autonomy and to return to their life back at college. But the parents want assurance that the eating disorder is not active and putting their child in danger.

Vicky was really excited about using SMART goals for Alex. “I feel like this is going to really help us put together a plan that feels good for all of us,” she says. “Alex would much prefer zero controls, and I get that, but I need something to make sure I’m not being reckless or thoughtless when sending them back to school.”

Working on SMART goals

Vicky worked on three SMART goals that she felt were important. Since they are in family therapy and Vicky was unsure how Alex would respond, she brought up the idea during a family therapy session. The therapist was encouraging and supportive of the idea, and Alex didn’t hate it. So the next week Vicky brought in the SMART goals worksheet. Together they worked with the therapist and Alex to make adjustments that felt good for everyone. 

“A big deal for Alex was the time-bound aspect, of course,” says Vicky. “Alex just wants to see a path out of being monitored all the time, and I feel like these SMART goals give us all the confidence to move forward. I want Alex to feel independent and free … and I want to be free of the eating disorder, too! This has absolutely taken over our lives, and I can’t wait to move into the next stage and reduce our monitoring.” 

This steady and clear approach to eating disorder recovery adds a lot of confidence and security for parents while also showing kids the steps they need to take to reclaim the independence they crave.

SMART goal template & examples

SMART goals for recovery example: eating

PLEASE NOTE: this is not intended as or delivered as medical advice. Please don’t make choices about your child’s recovery without consulting their treatment team. Make sure your SMART goals are appropriate and make sense in the context of your child’s eating disorder recovery.

SMART goals for recovery example: therapy

How to make a SMART goal

Like Vicky, you may be excited about SMART goals and want to dive right in. I get it! I love SMART goals! Please just remember that while Vicky drafted some SMART goals, she checked with her family therapist before introducing them to her child. Depending on your child’s eating disorder recovery status, SMART goals may not be the right approach right now. Check with your child’s treatment team before presenting your child with SMART goals.

To make a SMART goal, begin by thinking of your big goal, then breaking it down into behaviors that will get you closer to the goal. With eating disorders, the big goal is “recovery,” but that’s hard to measure and it’s a state of being, not a behavior with measurable steps. If we make recovery the goal, we will struggle to measure and monitor it. Instead, break it down into attainable, measurable, and observable behaviors like:

  • Eating regular meals and snacks
  • Checking vital signs of health such as heart rate, blood pressure, etc.
  • Going to therapy and nutrition appointments
  • Getting blind-weighed if appropriate/necessary

Next, write down a few SMART goals that are “specific,” “measurable,” “attainable,” “relevant,” and “time-bound.” If the goal is eating regular meals and snacks, detail how many meals and snacks, and how the goal will be measured. The most common mistake is not being very specific about the goal. The more specific and measurable the goal, the greater your chances of success.

Vague GoalsSpecific Goals
Eat regularlyText photos of 3 meals and 2 snacks every day
Don’t lose weightGet blind-weighed once every two weeks*
Stay healthyGet your vital signs checked once every two weeks*
Take care of yourselfAttend weekly therapy and nutrition sessions

*the frequency will vary based on your child’s current medical status and is here as an example only. Please consult your child’s treatment team to set goals that make sense for their individual recovery path.

Measuring success

The most motivating eating disorder goals are those that provide a pathway out of being monitored. Show your child the path to self-management by setting multi-stage SMART goals. 

For example, if the first goal is for them to attend therapy weekly for 8 weeks, that doesn’t mean you stop all therapy if they reach that goal. Maybe the next goal is that they switch to every 2 weeks for 8 weeks after that, then monthly. A stepped approach will provide the safest structure for recovery

SMART goals should never feel punitive or shameful. The value of providing time-bound goals is so your child knows what will happen when they meet the goal. But you should not say you are disappointed if your child does not achieve the goal by a certain date. That’s why I suggest using consecutive weeks rather than a specific date. Just count the weeks that they do accomplish the goal. If they skip a week, then you start again at 0. Once they do it every week in a row for the number of weeks specified you can celebrate and set a new goal. 

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Setting the clock

For example, Alex might text photos of their meals every day for two weeks in a row, then skip a few days during the third week. Alex is not bad for doing this. It’s understandable. However, that resets the clock back to 0. Once Alex texts all meals/snacks for 7 days, that puts the clock at 1. If the goal is 8 weeks, then Alex must text all meals/snacks for 7 days in a row for 8 weeks in a row to meet the goal. 

Avoid being flexible or changing the goal, because it will show your child that the goals are open for negotiation and debate. This is a slippery slope that eating disorders love to take advantage of. Instead, maintain clear, compassionate boundaries. It sucks for all of you to start at 0 again. But that’s how you make sure you aren’t accidentally accommodating the eating disorder.

Celebrating success

I checked in with Vicky after Alex had been back at college for a semester. She had been both hopeful and terrified of the return to college. And I’m pretty sure Alex felt many of the same feelings! 

Alex struggled a little bit with the transition back to school, which we expected and had prepared for. But after 4 weeks of being inconsistent with their progress, Alex stayed on track and they are almost ready to set new SMART goals that give Alex more freedom and autonomy. 

Vicky says that having SMART goals is a huge relief for her. “I just feel like I have some level of insight into what’s going on for them at college. Now I can keep an eye on their health and safety when they’re so far away from me.”


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

For privacy, names and identifying details have been changed in this article.

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3 brutal truths about kids’ body image

Kids’ body image report: 4 brutal facts

I’m going to level with you: I didn’t like writing this article about the brutal truths about kids’ body image. As someone on a mission to empower parents to raise kids who are free from body hate, it hurts my heart that this research indicates that our kids are definitely not free from body hate. 

From my perspective, two things are going on right now. First, we have high rates of dissatisfied body image in kids and the problems that arise from that, including eating disorders. Second, I see some progress in how our society treats bodies. We’re seeing more acceptance of the fat acceptance movement. And while the “body positive” movement is fairly problematic, it has expanded people’s ability to see beauty in a variety of body sizes.

Lizzo’s Watch Out for the Big Grrrls show is an example of a powerful shift in media. Her own performances on stage are athletic and powerful. And this show makes it clear that higher weight and fitness are not opposites.

Lizzo’s show is important because a significant driver of body image is the media. Our kids consume constant messages about bodies and so-called wellness programs, cleanses, weight-loss journeys, fitness challenges, and more. Engaging with media today almost always means learning dangerous beliefs and behaviors disguised as empowerment and self-care.

It’s not easy out there, but keep reading. Because at the end of the tough stuff I’m about to share, I’ll give you some ideas for how you can improve your child’s body image. There are a lot of things you can do, and you have the power to keep your child safe despite the fact that we live in a nasty societal soup of negative body image.

Here are three brutal truths about kids’ body image:

1. Most people have bad body image

All kids live with grownups, and that’s bad news for their body image. A Glamour magazine survey showed that 97% of women report having at least one negative thought about their body image every single day. Almost all women and about half of all men are dissatisfied with their body image.

In a 2019 survey of UK adults, one in five adults felt shame, 34% felt down or low, and 19% felt disgusted because of their body image in the last year. Around 35% of adults felt anxious and/or depressed about their body image. And 13% experienced suicidal thoughts or feelings because of their concerns about their body image. 

Many of these adults are parents, and body image issues tend to trickle down. A 2016 Journal of Pediatrics study found that more than half of children aged 9-14 years old were dissatisfied with their body shape. 

But of course, it’s not the parents’ fault. We live in a societal soup of body hate. Bodies are ridiculed, shamed, and discriminated against every day. 

Our kids’ doctors, teachers, coaches, friends, and extended family all teach them that bodies are something to be evaluated and judged. Add to that entertainment media like TV, movies, advertising, and video games, and harmful body image messages become inescapable. And that’s before social media, which is a known (and serious) contributor to poor body image.

2. Girls have bad body image

I think most people realize that girls are likely to have negative body image. After all, female bodies are constantly objectified, and the media, entertainment, beauty, and fashion industries endlessly promote very thin, white, and idealized female bodies. The pressure on the female body to be conventionally beautiful, thin, graceful, and “perfect” is intense. And the data shows that our girls feel this pressure.

  • 50% of 13-year-old U.S. girls and 80% of 17-year-old U.S. girls are unhappy with their bodies. [1]
  • 80% of teenage girls worry about becoming fat. [1]
  • 40-60% of elementary school girls are concerned about becoming “too fat.”[2]
  • 40-60% of girls reported feeling worried about their weight. [2]
  • 80% of teenage girls report fears of gaining weight and of being in a larger body. [1]
  • 36% of German girls felt fat, 22% were terrified of gaining weight, and 36% reported regularly feeling upset about their weight or shape. [3]
  • 50%  of Spanish girls expressed a desire for a thinner body, despite having a lower body weight. [4]

3. Boys also have bad body image

But it’s not only girls who suffer from bad body image. Boys are increasingly reporting negative body image. While girls almost always want to be thinner and conventionally beautiful, boys are just as likely to want to be more muscular and larger. In the past 10-20 years the highly-muscular male body has become increasingly idealized and objectified, driving boys and men to develop what’s called “bigorexia.” Boys increasingly use protein powders, special diets, extreme workouts, and sometimes steroids to pursue the ideal of a lean and muscular body.

  • 25% of U.S. boys were concerned about their muscularity and leanness and wished for toned and defined muscles. [5]
  • 17% of Australian boys were dissatisfied with their bodies. [6]
  • 3% of Australian teenage boys report body dysmorphic symptoms. [7]
  • 30% of U.S. teenage boys reported a desire to gain weight to be more muscular. [8]
  • 17% of U.S. teenage boys perceived themselves to be underweight, despite being of normal weight. [8]
  • Among Australian teenage boys, 12% met the criteria for an eating disorder characterized by marked body image disturbances. [8]
  • 20% of German boys felt fat, 15% were terrified of gaining weight, and 25% reported regularly feeling upset about weight or shape. [9]

What parents can do to improve kids’ body image

Parents have a significant impact on how kids feel about body image. We have the power to counteract the dangerous societal messages that teach kids to feel bad about themselves and strive for impossible body standards. Here are a few tips for parents who want to help kids have better body image: 

1. Respect your body

You are your child’s most important model. How you feel about and treat your body matters! Your body is not a project, and it’s not something that you need to control and dominate. The best science available shows that people who follow the principles of Intuitive Eating tend to have the greatest health. These principles include not trying to control for weight or achieve a specific weight or size. Learn to feed your body well, move it, rest it, and care for it with the dignity and respect it deserves. Your children are watching!

2. Respect other people’s bodies

Other people’s bodies are none of your business, and gossiping about them is wrong. Catch yourself when you’re tempted to comment on someone else’s body either positively or negatively. Focus instead on other qualities. If you hate someone, rather than focus on how fat they are, explore which character traits bother you, and talk about those. Their weight is not a character trait. If you love someone, rather than focus on how beautiful they are, find out what character traits draw you to them, and talk about those. Of course, you can point out neutral characteristics when necessary. Saying things like “she has long hair,” or “he’s very tall,” is not the same as making a character judgment based on someone’s weight. We should all know the difference and teach it to our kids.

3. Respect your child’s body

I know there is a ton of fear-mongering about kids’ bodies and weight out there. I get it. It’s scary to be a parent when it feels as if how we feed our kids is critically important to their health. The evidence shows that parents do influence lifelong health, but not in the way you think. A restricted diet, rigid exercise program, and worrying about their weight will not improve their relationship with their bodies. What does improve body image? Serve family meals daily and enjoy each other while eating. Serve a wide variety of foods, including fruits and veggies but also desserts and snacks. Be active and move your bodies as a family. Establish sleep schedules and keep them sacred (with age-appropriate modifications) all the way through high school. These actions will benefit your child’s lifelong health, regardless of their weight today or in the future because they are about respecting the body and treating it with love.

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4. Teach media literacy

Most adults do not believe they are influenced by the media, but the data shows otherwise. We are all deeply impacted by media portrayals of what it means to be good, successful, and loved in our society. And in the current media and social media environments, thin people are portrayed as all of those things, while fat people are portrayed as bad, unsuccessful, and unhappy. Actively teach your child about media literacy and the impact of media representation on what we believe. Home is where our kids consume most of their media, so it’s important to regulate media consumption and talk about it regularly. Don’t let your 8-year-old consume social media without supervision and limits. You can gradually reduce your limits as your child ages, but never stop talking about the influence of media on how we feel about ourselves and others.

5. Look out for signs of trouble

In our society, it is extremely hard to feel 100% positive about your body all the time. Your child will likely have negative body image moments, days, and possibly more. But keep an eye out for if your child’s body image is impacting their psychology and/or behavior. Don’t allow dieting or food restriction of any kind in your home, as dieting is a major indicator of and driver of poor body image. It’s also the most significant precursor to eating disorders. If you believe your child has a negative body image that is impacting them in a significant way, seek support from a non-diet mental health professional who is trained in body image issues.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

References

[1] Kearney Cooke, A., & Tieger, D. (2015). Body image disturbance and the development of eating disorders. In L. Smolak & M. D. Levine (Eds.), The Wiley Handbook of Eating Disorders (pp. 283-296). West Sussex, UK: Wiley

[2] Body Image, Second Edition: A Handbook of Science, Practice, and Prevention, Cash and Smolak, 2011

[3] Schuck, K., Munsch, S., & Schneider, S. (2018). Body image perceptions and symptoms of disturbed eating behavior among children and adolescents in Germany. Child and Adolescent Psychiatry and Mental Health 

[4] del Mar Bibiloni, M., Pich, J., Pons, A., & Tur, J. A. (2013). Body image and eating patterns among adolescents. BMC public health, 13(1), 1-10

[5] Calzo JP, Masyn KE, Corliss HL, Scherer EA, Field AE, Austin SB. Patterns of body image concerns and disordered weight- and shape-related behaviors in heterosexual and sexual minority adolescent males. Dev Psychol. 2015;51(9):1216–25

[6] Mond J, Hall A, Bentley C, Harrison C, Gratwick-Sarll K, Lewis V. Eating-disordered behavior in adolescent boys: eating disorder examination questionnaire norms. Int J Ea t Disord. 2014;47(4):335–41

[7] Schneider, S. C., Mond, J., Turner, C. M., & Hudson, J. L. (2017). Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact. Psychiatry research, 251, 125-130

[8] Nagata, J. M., Bibbins-Domingo, K., Garber, A. K., Griffiths, S., Vittinghoff, E., & Murray, S. B. (2019). Boys, bulk, and body ideals: Sex differences in weight-gain attempts among adolescents in the United States. Journal of Adolescent Health, 64(4), 450-453

[9] Schuck, K., Munsch, S., & Schneider, S. (2018). Body image perceptions and symptoms of disturbed eating behavior among children and adolescents in Germany. Child and Adolescent Psychiatry and Mental Health

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Treat the parent, help the child recover from an eating disorder

Treat the parent, help the child recover from an eating disorder

Alicia knew she had to do something soon. Her daughter Eden had been stuck in a restrictive eating disorder for a few years. Eden was medically stable and in treatment. But Alicia knew that she was still deeply affected by her eating disorder. And the eating disorder was taking up a lot of space in the family and for Alicia personally. Alicia wanted to make sure she was doing everything in her power to keep things from getting worse. 

Alicia started a parent-based treatment called SPACE (Supportive Parenting for Anxious Childhood Emotions). The program included 12 Zoom calls, plus homework and practice in between. Alicia learned ways to support Eden without accommodating anxiety-driven eating disorder behaviors. At the end of the program, Alicia noticed improvements in her daughters’ eating disorder behaviors. And she gained a new perspective on how she was parenting and skills to support Eden’s recovery.

“I was unsure how I could actually do anything to change the eating disorder. Mostly I was afraid to even try. But deep down I had a suspicion (A dream! A fear!) that there was more I could do. In SPACE training I became aware of how much I was accidentally accommodating the disorder. And in fact, it was those moments when I felt like I was being most supportive and loving that I was accidentally making things worse,” says Alicia.

“Now, I am really supportive … even more supportive than before. But I also have really good boundaries and I’m not getting into dangerous waters by accommodating Eden’s anxiety. I no longer avoid the hard things we need to do to get better,” says Alicia. “When I first learned what I had to do I thought it would be harder to parent this way. But in fact, things are running more smoothly now than they were before.”

Parent training for eating disorder recovery

As a parent, you did not cause your child’s eating disorder, but you have a critical role in recovery. New research is revealing that you can help treat your kids’ anxiety-driven eating disorder behaviors, improve your relationship, and boost your child’s flexibility and resilience by participating in SPACE parent-based treatment. These skills will last a lifetime and might change the course of your child’s recovery from their eating disorder.

SPACE is about learning to recognize parental accommodation and establish a new way of responding to anxious behaviors. When applied in eating disorder situations, SPACE can address anxious behaviors like food restriction and rituals, body-checking, and body comments. It teaches you to focus on your behavior rather than your child’s behavior since that is what is within your control. Parent training can be done either as part of a group or one-on-one. The skills taught in SPACE for eating disorders include: 

1. Creating a daily routine of consistent family meals and building family connections.

2. Identifying which eating disorder behaviors are coming from anxiety and how your responses accommodate the anxiety.

3. Creating a plan for which accommodations you want to target and how you will respond differently to anxiety in the future.

4. Implementing your plan and removing your accommodation for one anxiety-driven behavior at a time.

5. Practicing and refining your approach and choosing additional targets.

How SPACE works

The SPACE parent treatment program was developed and validated by scientists at Yale University. Its original use was with kids who have anxiety disorders and obsessive-compulsive disorder (OCD). A more recent version of SPACE was developed specifically for kids with avoidant restrictive feeding intake disorder (ARFID). SPACE has also been evaluated in children who have ASD, ADHD, and challenging behaviors like physical violence and threats of suicide.

The evidence-based parent treatment usually takes place over the course of 8-16 weeks. Parents join one 1-hour meeting per week and complete homework and practice between sessions. The first several sessions focus on parent education, and the additional sessions involve the parents implementing their plans and refining their skills.

Is anxiety a factor?

If anxiety is a factor in your child’s eating disorder behaviors, then SPACE can be appropriate. Many eating disorder behaviors are driven by anxiety, including:

  • Food avoidance: eating only at particular times, in particular places, a very limited list of foods, etc.
  • Food rituals: measuring, counting, arranging, hiding, mashing, throwing food, etc.
  • Body checking: weighing, pinching, measuring, etc.
  • Body talk: frequent questions like “am I fat?” “will this make me fat?” “I’m so fat” etc.

If your child is not medically stable and/or is in Stage 1 of family-based treatment (FBT), then your targets will not be food behaviors. But if your child is home with you then it may be appropriate to apply the treatment to body checking, body talk, or other anxious behaviors that are not directly linked to the eating disorder.

Why SPACE?

I provide SPACE parent-based treatment for eating disorders because it gives parents evidence-based skills to treat anxiety-driven eating disorder behaviors. It’s an excellent option for dedicated parents who want to do more.

“There’s a sense of action and empowerment in SPACE, and I found myself feeling more hopeful than I’ve felt since Eden first started showing signs of an eating disorder,” says Alicia. “I felt so powerless so many times in the past few years, and this is the first time I’ve seen real progress in a long time.”

“I felt really connected to the other parents in my SPACE group,” says Alicia. “It was as if we could all take a collective deep breath and feel less alone in all of this. I think we were all like shaken soda cans in the beginning. We looked fine on the outside but we were ready to burst. By the end, we were sharing our successes and sometimes laughing together. There was a real sense of community and shared safety.”

Setting goals

A key goal of SPACE parent training is seeing a reduction in anxious behaviors. Parents identify the eating disorder behaviors they want to see reduced and then work towards their goals by changing their (the parents’) behavior. You can help treat your kids’ anxiety-driven eating disorder behaviors with this parent-based treatment. Target behaviors might include: 

1. Food refusal goals might include expanding the list of “safe” foods. 

2. Food ritual goals might include eating a meal without hiding food.

3. Weight ritual goals might include not using the bathroom scale.

4. Body talk goals might include fewer meltdowns over body appearance.

5. Treatment resistance goals might include less debate and negotiation about treatment plans and participation.

At the end of SPACE treatment, parents review the goals they are achieving and the goals they still have. The parents’ focus remains on ending their accommodation of anxiety-driven eating disorder behaviors since parental accommodation is a “maintaining factor” in eating disorders. But the results of the treatment will also be apparent in the child. There is good evidence showing that SPACE parent treatment results in a reduction in the quantity and severity of anxious behaviors by the child.

What results can I expect?

Could SPACE parent treatment be what your child needs to get further into their recovery? That depends on many factors, including how entrenched your child’s eating disorder is, your own ability to commit to and follow the treatment, and the consistency with which you practice your new skills at home. 

Kids may need to continue their own treatment even when parents change their behavior. Eating disorders are complex and multi-factorial, so the ongoing involvement of a therapist, dietitian, and physician may be necessary for the foreseeable future. The main opportunity with SPACE parent treatment is for you to know that you are doing everything in your power to support your child’s recovery and nothing that will interfere with recovery.

Some parents who complete SPACE treatment see improvements very quickly, but while things will feel easier and you’ll feel more confident in your own behavior, this is not a miracle treatment. It will take time for you and your child to learn a new way of relating to anxiety-driven eating disorder behaviors.

Facing difficulties

Sometimes your child’s behavior may get worse before you see improvements. This is a known phenomenon called an “extinction burst.” You’ll learn the skills you need to stay steady in the face of anxiety escalations and will work on your own emotional regulation in times of stress. Anxious behaviors are driven by “body-up” sensations and are therefore not intentionally manipulative or coercive, but to parents, that’s exactly what they feel like. 

Your desire to reduce your child’s distress and disruption will feel overwhelming at times, but you’ll have the knowledge and skills you need to respond without accommodation. Being a sturdy, strong parent when your child desperately wants you to accommodate their anxious demands will take time and practice. The SPACE parent-based treatment helps you treat your kids’ eating disorder behaviors and face these difficulties with confidence.

Extinction bursts don’t typically last long, and if you can stay the course, maintain the plan, and practice your skills, both you and your child will feel better soon. The result is fewer anxiety-driven eating disorder behaviors, confidence that you are doing the right thing, and a more connected and relaxed relationship with your child. 

Give it time

Learning to hold yourself steady in the face of a powerful anxiety-driven eating disorder escalation is hard. While every parent wishes for overnight success, SPACE parent-based treatment is more about consistent improvement. You might not see the magic happening every day, but if you stick with the plan you’ll see big changes over time.

A major side effect of SPACE treatment is a reduction of “caregiver burden,” which is significant with eating disorders and can impede recovery. You’ll feel more confident and less overwhelmed and hopeless. And that alone is a major benefit of the SPACE parent-based treatment to treat your kids’ anxious eating disorder behaviors.

That’s what happened with Alicia. The first few weeks of SPACE challenged everything she thought she should be doing to support Eden. But a few weeks later, she could sense a difference in their relationship. “There was a lot less stress at mealtimes and other times we spent together,” she said. “I didn’t even realize the burden I was carrying. But now I see that I was trying to do everything right, and I was constantly walking on eggshells, afraid to make things worse. I worried all the time. But then I learned that my avoidance had actually empowered the eating disorder. Now that I know how to safely stand up to anxiety, I feel stronger and more effective.”

“Eden is still seeing her therapist weekly, but she is firmly in recovery now,” says Alicia. “We still have work to do individually and as a family, but I’m at least sure that I’ve reduced my accommodations and am doing everything in my power to keep Eden healthy.”

You can learn more about the SPACE treatment for parents who have kids with eating disorders here.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

For privacy, names and identifying details have been changed in this article.

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How to stop nagging and negotiating with your kid who has an eating disorder

Get your kid with an eating disorder to eat without nagging and negotiating

If your kid has an eating disorder, then there’s a good chance you are constantly nagging and negotiating with them to eat. How many reminders have you given your child this week? A certain level of reminding is to be expected. But if it feels constant and never-ending, then it’s probably time to make a change. This is because of two things: 

  1. Constantly reminding your child to do things is exhausting, especially when you’ve already explained why it’s important a thousand times. Reminding your kid to do something as essential as eating is a huge burden on you that will lead to burnout.
  1. When you nag and negotiate with your child to eat, you are essentially “owning” their food and eating, meaning they are not taking responsibility for their own nourishment and recovery. While this helps for short-term problems, it’s ineffective for long-term issues.

Maybe you lean more towards negotiation: “Eat just one more bite and then you can be finished.” Or “If you eat this, you don’t have to eat that.” 

Or perhaps you find yourself nagging: “Did you remember to eat?” “Please remember to eat!” Or “You have to eat fat and carbs!”

Either way, if you feel as if you’re in an endless loop of negotiation and nagging, it doesn’t mean you’re not trying hard enough. It’s just a sign your current system isn’t working.

Changing exactly how you ask your child to do something might help a little bit in the short term, but often the issue is a lot more complicated and relates to how eating disorders work and how our best intentions can sometimes get in the way of recovery.

If you find yourself exhausted by the constant nagging and reminding, here are some ideas to get you and your child to a different level.

SPACE treatment for eating disorders

The SPACE treatment stands for Supportive Parenting for Anxious Childhood Emotions. It’s a research-backed program to help parents stop accommodating or enabling eating disorder behaviors and start making it really uncomfortable for them.

I’ve adapted SPACE for eating disorders (BED, EDNOS, bulimia, anorexia, and ARFID) because of two things. First, anxiety drives most eating disorder behaviors. People who have eating disorders are often genetically predisposed to be highly-reactive, and therefore more sensitive to anxiety. Food restriction, rejection, and rituals are powerful coping mechanisms for anxiety and distress. Second, parental accommodation, which includes nagging and negotiating, has been identified as a maintaining factor in eating disorders. It has been associated with greater symptom severity and caregiver burden. SPACE addresses both your child’s anxiety and parental accommodation.

Beyond getting your child into treatment and feeding them regularly, eliminating parental accommodation is one of the most powerful actions you can take to stop the eating disorder. The best part is that removing parental accommodation does not require the child to be engaged or motivated to change. It’s entirely up to you.

In this article, I’ll take a look at some ways parents can use the SPACE approach to stop accommodating eating disorder behaviors.

1. See nagging for what it is 

When there’s an eating disorder you probably have spent time nagging and negotiating about food and eating. Over time, this is exhausting for parents and can actually make kids more (not less) resistant to eating.

Most parents who nag and negotiate believe that if they just say the right thing a switch will go off in their kids’ heads and they’ll start to eat. These parents are trying valiantly to convince their children that eating is good and healthy and that the kid should do it. 

But if you have any experience with this, then you know that it rarely works.

Nagging and negotiating about eating and food are a sign that your system is not working. You’re tired, and your kid isn’t changing. It’s not that you aren’t trying hard enough. Or that you haven’t said the right thing yet. It’s that you’re using the wrong approach.    

In SPACE for Eating Disorders treatment, we work on stopping the endless loop of nagging and negotiating. Parents learn to create clear interpersonal boundaries and attend to the underlying drivers and beneath-the-surface communication that’s going on every time you and your kid start to butt heads.

2. Make what’s unseen, seen

An eating disorder loves the shadows. All it really wants is to be able to exist and flourish without a lot of talk or disruption. It believes that it’s got things under control and that your involvement is threatening and unnecessary. But the last thing you want to do is adhere to an eating disorder’s demands for secrecy. In fact, you want to do the opposite: bring disordered behaviors into the light and talk about them openly.

Of course, it’s very important to not be critical or threatening toward the eating disorder. There’s a huge difference between criticism and observation, and they are mortal enemies. You want to be respectful of the eating disorder while calmly observing what’s going on. 

“Oh, it seems like you’re feeling upset about eating right now. I get that it’s hard, but I’m 100% confident you can do this.” 

That’s very different from “Stop trying to hide food under your napkin! I can see what you’re doing!”

The former is supportive. The latter is threatening.

In SPACE for Eating Disorders treatment, we work on isolating a single behavior and figuring out exactly how parents will respond differently when it shows up. Then we write a letter to the child calmly and compassionately explaining the behavior and how the parents will respond from now on. This is an essential step in overcoming the eating disorder’s demands for secrecy and privacy.

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3. Don’t wait for them to get on board

One of the hardest things about having a child with an eating disorder is the persistent belief that the child must be “on board” in order for them to recover. And of course, your child will need to own recovery for themself. You can’t do that for them.

But that doesn’t mean you have to wait for your kid to get on board in order for you to make changes. You can start making changes today that will impact your child’s likelihood of considering and ultimately embracing recovery. 

Without parental changes, it’s much less likely that the child will even consider eating disorder recovery. Because as hard as it is to have an eating disorder, the idea of living without one is so terrifying that most people remain stuck in the loop of eating disorder behaviors. 

In SPACE for Eating Disorders treatment, parents make unilateral changes in their behavior. This means we determine the ways in which you are accommodating the eating disorder and you learn how to stop doing that. These changes are about your motivation and commitment. They do not require your child to change; only you. 

5. Don’t just say it, show it

Nagging and negotiation are all about what you say. But eating disorder behavior works on a much deeper level. In fact, anxiety-driven behavior barely responds to language. It’s a deep, animalistic instinct. It responds to action. 

This is why nagging and negotiating rarely change the course of an eating disorder. The drivers of the eating disorder are much deeper and more primitive than language. And the eating disorder actually enjoys pushing back against nagging and negotiating because it’s a great distraction from what’s really going on.

In SPACE for Eating Disorders treatment, parents learn to show how they want their child to behave rather than ask for compliance. This means parents stop talking so much and instead show calm, compassionate confidence even in the most violent emotional storm. 

6. Practice, not perfect

One of the biggest impediments to lasting change is when we think it’s an event instead of a process. Eating disorder recovery is not a single-day event. It’s something that your child will need to practice in some form for the rest of their lives.

Many parents feel some success if they need to nag and negotiate a bit less. They may think the eating disorder is in remission. But then something happens and it looks like their child is suddenly right back to where they were before. This should not be a surprise. Remember that eating disorder behaviors are a response to stress, so every time there is a stressor, you can probably count on the eating disorder showing up again in some way. 

In SPACE for Eating Disorders, parents learn to anticipate kids’ behavioral cycles and respond consistently and calmly no matter what’s coming up. This means parents have learned not just a script or a single response, but an entirely new system for responding to eating disorder behaviors. 


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.