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TikTok is dangerous for body image and eating disorders

TikTok is dangerous to kids' body image and likely increases the risk of eating disorders.

A new study found that TikTok videos focusing on “health” are dangerous for body image, promote weight loss, and may encourage eating disorders.

TikTok’s most-viral “health” videos overwhelmingly say that weight loss and thinness are achievable and desirable for all. TikTok is a major force in our kids’ lives, and it perpetuates harmful weight stigma and diet culture. It’s no surprise that the rise of social media coincides with the fact that eating disorders are skyrocketing.

Research has linked social media usage in adolescents and young adults to disordered eating and negative body image. This is most likely due to the prevalence of diet culture themes on social media, a primary source of information for many kids, teens, and young adults. Additionally, adolescent girls who report more time spent on social media are more likely to have high internalization of the thin ideal, a risk factor for eating disorders. TikTok is dangerous to kids’ body image and likely increases the risk of eating disorders.

tiktok body image eating disorders

The danger of TikTok

“Each day, millions of teens and young adults are being fed content on TikTok that paints a very unrealistic and inaccurate picture of food, nutrition, and health,” said Lizzy Pope, associate professor and director of the Didactic Program in Dietetics at UVM.

Kids, teens, and young adults who create and engage with weight or food-related content on TikTok are at higher risk of having internalized body image and disordered eating behaviors. TikTok’s viral weight loss content is a powerful megaphone for diet culture. TikTok videos spread common beliefs: 1) you should lose weight; and 2) you should eat less and move more to lose weight. However, the data shows that these beliefs are inaccurate and harmful. Also, they are the foundation of eating disorder beliefs and behaviors. 

Eating disorders are pernicious and deadly. The last thing we need is a powerful social media app feeding our kids warped messages about health and wellness. But that’s what we’ve got. Here’s some more information for parents about TikTok and the risk it poses to body image and eating disorders. Keep reading for guidelines to protect your kids from the dangers of TikTok.

What is TikTok?

TikTok went worldwide in 2018 and has been downloaded over two billion times globally. Most TikTok users are Gen-Z (born in the mid-1990s to mid-2010s). In July 2020, TikTok reported that one-third of its 49 million daily users were at or below the age of 14. This youthful market means that TikTok is an important driver of cultural trends. 

TikTok is like Instagram or Twitter in that you can follow and like posts from specific accounts. But the app doesn’t require a person to follow certain accounts to view posts tailored to them. The default page for the app is a “for you” page with endless, algorithmically curated videos that the app has determined fit your preferences. Users report that the “for you” page on TikTok is eerie in its ability to create a crave-worthy feed that feels custom-made. 

TikTok is driven by a powerful algorithm that learns a person’s likes and preferences. That means the more a person interacts with kitten and puppy content, the more kittens and puppies they will see. Similarly, the more they interact with diet culture and weight-stigmatizing content, the more of that they will see. This is why TikTok is so risky to kids’ body image and promotes eating disorders.

What is a hashtag?

Hashtags are a way that social media algorithms group similar content together. It’s the # symbol followed by a word or phrase. On TikTok, users can add hashtags to their captions to help the algorithm direct people to their content. Hashtags are a serious driver of the powerful TikTok algorithm, which is credited with its massive popularity among young people. However, hashtags and the algorithm are also why TikTok is especially dangerous when it comes to eating and body image. If someone starts liking content associated with weight stigma and diet culture, they will receive much more of that content. 

The following data about TikTok is from this study: Weight-normative messaging predominates on TikTok—A qualitative content analysis, published November 1, 2022, in PLOS One

tiktok body image eating disorders

Glorification of weight loss

“The majority of posts presented a weight normative view of health, with less than 3% coded as weight-inclusive,”

Weight-normative messaging predominates on TikTok—A qualitative content analysis  

Nearly 44% of all videos examined in the study had content about weight loss, and 20% showed a weight transformation in the video. A recurring theme is that if you just try hard enough, you can lose weight. These messages are often wrapped up with health claims that weight loss and low body weight are healthy.

The weightloss hashtag alone has almost 10 billion views at the time of the study. Many videos depicted weight loss transformation achieved through exercise routines and diet plans, often showing weigh-ins and clothing “downsizing.” Exercise was portrayed not for its many health benefits but for its potential to aid weight loss. 

The videos use phrases like “no excuses,” “get up,” and “if you want it bad enough, you’ll do it.” This is a siren song for anyone with an eating disorder, cheering on the eating disorder behaviors and exacerbating the illness.

Diets and fads

Thirty-eight percent of videos explicitly showed food (cooking, eating, getting take-out, etc.), and 11.9% of videos featured active cooking. However, there was a clear theme that food was seen as a way of pursuing health or wellness rather than something fun and enjoyable. 

In 47% of videos with the hashtag “nutrition,” the video provided nutrition advice about what foods to eat. As expected, most offered advice about how to eat for weight loss. It was common for the video to pair a weight loss transformation with a “what they ate” sequence showing how they achieved their weight loss. 

Diets were presented as a way to achieve a “body goal.” About 14% of videos mentioned a specific fad diet or dieting behaviors. The most popular fad diets on TikTok are: 

  • High-protein
  • Low-calorie
  • Liquid cleanses
  • Intermittent fasting
  • Weight loss or detox teas or drinks

Another popular trend on TikTok is to make “healthy” versions of “junk” food. This messaging perpetuates the myth that food carries the moral qualities of being either good or bad.  

Who is creating viral body-toxic content?

“Most posts were created by white, female adolescents and young adults.”

Weight-normative messaging predominates on TikTok—A qualitative content analysis  

The study found that 42% of the most popular posts were created by college-aged young adults, 28% by millennials and 11% were created by high school students. More than 64% of the videos were created by female presenting users and 56% by white-presenting individuals. 

There was a notable lack of body diversity. Only 16% of posts showed someone with a larger body. This means the viral content on TikTok perpetuates the thin ideal, a major contributor to eating disorders.

Of all the videos about nutrition, just 1.4% were created by registered dietitians. This means that users are sharing nutrition tips with zero qualifications to do so.

TikTok guidelines for parents

TikTok is an important part of kids’ lives today. You can shut down all access to TikTok in the short term if you are currently dealing with an eating disorder crisis. However, over time you will want to support your child in learning to manage limits and manage social media since it’s likely to be an ongoing part of their life. Here are some guidelines for doing this:

1. Set social media expectations and limits

Your child will not like you setting social media expectations and limits. Of course not. But this is an essential safety issue. Explain to your child that you own their phone and can access or confiscate it anytime. 

This feels harsh, but it is a required safety action that parents must take when a child is at risk. Just like requiring a seat belt in the car, you must insist upon social media oversight to keep your child safe. 

tiktok body image eating disorders

Help your child understand that access to social media apps like TikTok is contingent on healthy consumption of TikTok. Let them know you’re going to monitor their use to ensure safety. You will need to do random checks of your child’s TikTok “for you” feed. The benefit of TikTok’s powerful algorithm is that your child can’t hide the type of content they are engaging with. If they engage with diet and weight loss content, their “for you” feed will be full of it. If they aren’t, it won’t.

2. Set up a phone contract

Some basic rules for phone use should be: 

  • You may not actively engage in diet and weight loss content or content that I believe is weight shaming and harmful. We’ll keep talking about this, so you understand what I mean.
  • You’ll hand me your phone on request without protest as often as I ask. Failure to give me access to your phone will result in me confiscating it for hours, days, or a full week, depending on the situation.
  • You will not turn off or change the parental controls I set. If you believe something should change, talk to me and gain permission. If you make changes without permission, I will confiscate your phone. 
  • I will open and review your apps, for example, to see what’s in your “for you” feed on TikTok.
  • If I can see that you are unable to resist diet and weight loss content, I will remove TikTok and other social media apps from your phone indefinitely. If you add it back without permission, I will confiscate your phone.
  • I will not open and read your DMs unless I am concerned.
  • I will not open and read your text messages and emails unless I have reason to be concerned.
  • The more I see that you are using social media in a healthy way, the less I will check, but it will never be never.

If you’d like a complete list of rules you can edit and present to your child, you can get it here.

3. Set up parental controls

You can set up the following parental controls. 

  1. Set the account to private. Tap the menu icon in the upper-right corner of the profile and select Settings and Privacy, and choose Privacy. On the next screen, tap the button text to Private Account. 
  2. Set a time limit. Set daily time limits on using TikTok, schedule mandatory breaks that lock your child out of the app, and see a summary of how much time was spent using the app.
  3. Filter keywords. Within settings, go to Content Preferences to set the app to block videos containing certain keywords. Tap Filter Video Keywords to add keywords and hashtags you want to be restricted. You can also choose which feeds to filter.
  4. Restricted mode. Within settings, go to Content Preferences to enable the password-protected Restricted Mode. This attempts to limit exposure to videos that the platform deems unsuitable for all ages. You can enable the mode by selecting it on the Content Preferences screen and setting a password so it can’t be easily disabled.
  5. Link your account to theirs. The Family Pairing feature allows you to link your TikTok account to your child’s for remote supervision and management. You can control who can send your child direct messages and who can comment on videos.

Note: you may also want to set parental controls on your child’s phone.

tiktok body image eating disorders

Hashtags to restrict/avoid on TikTok 

  • #thinspiration
  • #fitspiration
  • #cheatmeal
  • #weightloss
  • #quarantine15
  • #diet
  • #weightlossjourney
  • #fatloss
  • #weightlosscheck
  • #whatieatinaday

4. Increase media literacy

A condition of using social media must be ongoing conversations about the risks and impact of social media. I suggest you talk about social media at least once per week. Ask your child questions like: 

  • Who do you follow?
  • What do you see on your “for you” page?
  • How do you feel when you look at diet and weight loss content?
  • Do you think the people who go viral with diet and weight loss tips are credible sources of health information?
  • Why do you think diet and weight loss content is so popular on TikTok?
  • What do you think is the formula for a viral video on TikTok?
  • How can you protect yourself from harmful content on TikTok?
  • What is some TikTok content that you think is healthy? Why? How can you get more of that in your feed?

Participation in these conversations should be a condition of continued social media access.

5. Teach your child to tell TikTok not to show more diet and weight loss videos

The best thing your child can do is not engage with body and food content. But TikTok’s algorithm will likely continue to add diet and weight loss content to their “for you” page. Ask your child to actively select “not interested” when this content appears. This is how to do it:

tiktok body image eating disorders

I wish we could trust our kids to use social media safely, but that’s unrealistic. TikTok is dangerous to body image and increases the risk of eating disorders. It’s built on a compelling algorithm. And just like we don’t let kids jump in the car when they want to go somewhere without oversight and conditions, we can’t let them go on TikTok without safety measures to protect them.

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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What to do when your child feels body shame

What to do when your child feels body shame

Eric has noticed that his child Mackenzie feels a lot of body shame. “It started with a few comments here and there,” he says. “But now she is constantly talking about how terrible her body is. She compares her body to everyone else’s and spends hours looking at herself in the mirror, pinching and criticizing herself.” 

Eric is not alone. Unfortunately, body shame is a common side effect of living in our culture. We have the perfect conditions for kids, particularly female and nonbinary kids, to feel self-conscious about how their bodies look. 

While many parents assume this is normal and a passing phase, Eric has good reason to be worried. Body shame is linked to low self-worth. It is a precursor to many mental disorders, including anxiety, depression, substance abuse, and eating disorders. While we can say that body shame is normal in our society, it is definitely not healthy. And parents can and should intervene to support their kids’ lifetime health and wellness. 

What is body shame?

Shame is a feeling that your whole self is wrong, not related to a specific behavior or event. When a person has body shame, it means they believe their body is intrinsically, essentially wrong and bad. They may attempt to make themselves feel better by manipulating their appearance. But it doesn’t work because body shame runs much deeper than appearance.

1. Understand our society and culture

Our society and culture are cruel to bodies. Bodies are constantly criticized, dominated, and treated as subservient to our brains. In our culture we worship at the altar of diet culture. This says that bodies should be thin, and that not-thin bodies must be controlled with diet and exercise. Diet culture also says that people who are not thin are less intelligent, beautiful, and worthy of time, attention, and love.

There is zero evidence of success in maintaining weight loss following a diet. And there is substantial evidence that dieting predicts weight gain. Yet the U.S. weight loss market reached a record $78 billion in 2019. Meanwhile, eating disorders are skyrocketing. And it’s no surprise: diet programs are basically how-to manuals for eating disorders. 

⭐ If your child feels body shame, you need to understand the cultural context. Body shame is baked into our society. Parents must consciously and intentionally counteract society’s discrimination against and domination of bodies. Parents also need to monitor social media use. They should limit overall time and reduce the number of body-toxic accounts that kids follow.

2. Understand your family’s culture

Families are the mini-culture in which our kids live. So how families feel about their bodies has a significant impact on how kids feel about their bodies. Families that criticize and dominate their bodies in the pursuit of thinness are more likely to have kids with eating disorders and disordered eating. They are also more likely to raise kids who diet. Dieting and weight control in childhood and adolescence predict higher BMI in adulthood.

Family cultures that assume that thin bodies are better than fat bodies cause significant harm to kids’ body image and lifelong health. This can be done actively, by telling kids that thin people are healthier and smarter than fat people. It can also be done passively, by never counteracting the societal messages that say those things.

⭐ If your child feels body shame, look hard at your family culture. This is not coming from a place of blame. If your family culture is body-negative, you are part of the vast majority of our culture. However, a body-negative family culture is a serious risk factor for kids. So take action to change your family culture around food, eating, and weight.

A word about the word “fat”

The term “fat” can be used as a slur or a neutral descriptor. In its neutral form, saying “fat” is the same as saying “tall” or “brown-eyed.” Other words for fat bodies, such as “overweight” and “obese,” are currently considered to be stigmatizing. Many fat justice leaders have reclaimed the word “fat” as the preferred neutral descriptor for their bodies.

However, we should not call someone “fat” unless we 1) are doing so kindly 2) have zero thoughts that they should lose weight; and 3) clearly have their permission to do so. And nobody should ever use “fat” as an insult. It’s always best to let people who live in marginalized bodies to define themselves rather than assuming a label on their behalf. And never tell a person in a larger body that they are “not fat” or should be proud to be fat. It’s their body and their choice to define themselves on their own terms.

3. Understand the link between body image and self-image

Two things are true. First, body image is a reflection of self-image. And second, self-image is often directly tied to body image due to our body-negative culture. Therefore, we simply cannot separate a child’s body image from their self-image, and vice versa. A child who feels shame about their body also feels shame about who they are as a person. Because our body is our physical manifestation of our personhood.

It’s a mistake to assume that body image is separate from self-image. This is why our body-negative culture is so deeply damaging to kids. A child who grows up in a body-negative culture is more likely to feel shame about themselves as a person. And shame is toxic to physical and mental health. 

⭐ If your child feels body shame, then remember that it’s not only about their body. Body image is directly linked to self-image, and the two cannot be extricated from each other. Don’t assume that you can “fix” body image without going deeper and addressing self-image and self-worth. Body image isn’t ever fixed by working on outside appearance. It will not be improved with a diet, weight loss, or exercise program. A fitness class or personal trainer can only superficially improve your child’s body image. Body image is an inside job. If necessary, get your child a non-diet therapist, coach, or counselor who can help them develop a healthy sense of self.

4. Change how you talk about bodies

Because we live in a body-negative culture, most people speak poorly of bodies. We were raised in these conditions and will unconsciously perpetuate them unless we actively work to overcome toxic patterns. Speaking as if weight is a moral responsibility, as if weight is within people’s control, and as if weight is directly linked to how much a person eats and exercises is harmful. This sort of language encourages eating disorder behavior and body shame. It also encourages discriminatory and incorrect beliefs about larger people. 

Learn why a non-diet approach to health is the healthiest. Find out why weight is largely out of individual control. And why it’s better for our health never to diet than to attempt to change our weight on purpose. Next, change your language about bodies. Remember that body image and self-image are the same things. And never speak about another person as if their body is an object to be manipulated. The body is an essential part of each person’s existence as a human being. All bodies deserve to be spoken of with dignity and respect. 

⭐ If your child feels body shame, they may bring up a lot of negative self-talk about their bodies. They may cry and scream about their bodies. Do not accept this as “normal” and wait for it to pass. How you respond to negative self-talk makes a huge difference, and it’s not easy. Learn how to respond to body bashing and negative self-talk to help your child build self-worth. 

Support your child’s self-respect and body respect

We live in a body-toxic culture. If I could change the culture, I would. But since cultural change starts at home, let’s focus on our families and the people we love. Learn to talk about bodies with respect. Stop dieting and trying to control bodies. And actively counteract our society’s harmful messages about bodies to help your child stop feeling ashamed of themselves. Your actions really make a difference!

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder

Family therapy when your child has an eating disorder may be the most important and the hardest thing you’ve ever done as a parent. Family therapy can help your family build belonging and resolve conflicts more easily. It can have a lifetime of benefits, including supporting eating disorder recovery.

But while therapy is ideally a safe space, when it’s family therapy, parents rarely feel safe. In fact, they usually feel uncomfortable at first. That’s because family therapy addresses family dynamics. And because you are the parent, and thus the head of the family, your behavior and parenting choices are naturally going to be evaluated and discussed. 

In family therapy, your child will get the lion’s share of talking time, for reasons I’ll explain shortly. This may make you feel shut down, shut out, disrespected and even furious. You want to be prepared for these feelings to show up. Because while they make perfect sense, they can get in the way of making progress. Family therapy is an opportunity to deepen your relationship with your child and support their recovery. It will be hard, but it will be worth it.

What is family therapy?

Family therapy is when family members are guided by a trained, licensed therapist to improve communication and resolve conflicts. Family therapy is different from family-based treatment (FBT), which is used for eating disorders. While FBT is about feeding, family therapy is about family dynamics. 

Family therapy is designed to help families:

  • Increase empathy and understanding 
  • Set and hold healthy boundaries
  • Build belonging and communication
  • Develop problem-solving and conflict resolution skills

If your child’s eating disorder treatment team has suggested family therapy, it’s best if you are informed and prepared. Here are the five steps you should take to prepare for family therapy: 

1. Set your goal

You want to go into family therapy with a clear goal. And while it may seem like the obvious family therapy goal is to fix your child’s eating disorder, that will not work. This is because family therapy is about working on your family dynamics, not solving a particular problem.

Family dynamics are the patterns of interactions among family members. It involves each person’s roles and relationships. Within families people adopt roles that can become fixed and unhealthy. And there are multiple dyads, triads, and other inter-relationships. These all need to be addressed individually and collectively. 

Family dynamics can either be supportive or a significant cause of stress. When we shift family dynamics from stressful to supportive, we can supercharge recovery. Thus, your goal in family therapy is to build more supportive family dynamics.  

2. Don’t expect equality

Family therapy is nothing like any other therapy you’ve experienced. If you’ve done individual therapy, you had 100% of the time to explain yourself and process your feelings. If you’ve done couples therapy, you had about 50% of the time. But in family therapy, your child’s experience of being a child in your family takes center stage.

You need to enter family therapy with a very clear understanding that this is not an equal playing field. While you may not realize it, you spent many years in a position of power over your child. That’s simply what it means to be a parent. Even if you felt powerless at times, the very nature of the parent-child dynamic is that you held tremendous power over them when they were a vulnerable infant, toddler, and child. This early dynamic shapes how they see you and relate to you, no matter how much things have changed since then.

In family therapy you and your child are not peers with equal perspectives. You will not get equal time. The therapist will encourage your child to express themselves and how they felt in the family. And that is where the healing begins. The more open you are to learning about your child’s perspective, the greater your success will be.

3. Don’t debate the “facts”

There is a good chance that your child will bring many stories and grievances to family therapy. They will have complaints about things you did and things you did not do. It is natural and normal to want to debate the facts of the situation. 

For example, if your child says you never cared about them, you will want to tell them all the ways you did care about them. If your child says you loved their sibling more, you will want to tell them the times you prioritized their feelings. 

But the facts are not the issue. And debating the facts will derail family therapy. Work on your own emotional regulation and prepare yourself to hear facts that you don’t agree with. Because you don’t have to agree with the facts. What you need to do is see the small vulnerable child who is asking you to witness the pain they experienced in childhood. What feels like criticism of you is actually a request for care from you. 

All children experience pain in childhood. No childhood is perfect. And you didn’t have to get things right in the past to be close with your child today. You just have to listen to their grievances with compassion and empathy and love them for who they are. The more you witness their pain with compassion and acceptance, the less they will suffer.

4. Don’t get defensive

It’s OK. You’re probably going to get defensive. It’s natural and normal to feel defensive when a child says something went wrong. But your goal is a deeper and more supportive relationship with your child. So you need to manage your defensiveness and not let it get between you and the vulnerable child who is asking you for emotional care.

Defensiveness sounds like this: 

  • But I did all this for you …
  • That’s not what happened
  • But what I meant was …
  • What I was trying to do was … 
  • I can’t believe you would say that
  • You’re wrong
  • What else was I supposed to do?

These sorts of statements will want to tumble out of your mouth. But it’s best to manage your defensive impulses. Your goal in family therapy is to deepen your relationship with your child. And these defensive statements will not help and may even make things worse. Defensiveness from you will shut down the therapeutic process.

Work on your defense triggers in advance with a therapist or coach who can help you process your feelings with compassion and understanding. Practice managing your defensive impulses so you can hear about your child’s experience without getting defensive.

5. Listen & validate

Of course you want your child to understand you. But don’t start there. Healing begins when your child feels understood. When that happens, they will be able to see you in a new, softer light. But if you try to keep the focus on your feelings, a wall will remain between you. 

You’ll need to listen far more than you speak during family therapy. I don’t want you to repress your feelings. This is about managing your emotions during family therapy so that you’re able to hear what your child has to say. If sitting in family therapy is going to require strenuous repression, then it’s too soon for family therapy. Take more time with your own therapist or coach first so that your own feelings are well on their way to healing before you do family therapy with your child. 

During family therapy you mostly want to make validating statements. When your child speaks, they are opening a door to a relationship with you. They’re saying “can you see my pain?” And the correct answer to this is some version of “I believe you, and I’m sorry for your pain. I love you, and I will always love you.”

Practice validating your child’s feelings. As I said before, you’ll be tempted to focus on the facts and details, but instead focus on the feelings they are sharing with you. Listen for feelings like: 

  • I felt sad when …
  • I’m angry about …
  • I wish you had … 
  • I’m not sure that you love me …

Hearing your child have these feelings can be heartbreaking. Anticipate that your child has big feelings that will come out in therapy and practice responding to them with validating statements before you go.

I know that family therapy when your child has an eating disorder is hard. But there are tremendous benefits if you can do it. The best thing you can do is keep your goal in mind and be prepared. 

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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Questions to ask eating disorder treatment centers

Questions to ask eating disorder treatment centers

It’s not easy making the decision to send your child to an eating disorder treatment center – you probably have a lot of questions. There are so many factors to consider and so many options out there. And right now there’s added stress because so many centers are at capacity and have waiting lists. 

I’ll review the basics of what it means to send your child to an eating disorder treatment center. Before we dive in, it’s very important to say that this decision is yours to make. Nobody should make the decision on your behalf.  My goal is to help you weigh your options. And I have confidence that you will make the best choice for your unique situation.

Sending your child to an eating disorder treatment center will be hard no matter what. But ideally, you should feel on some deep level that this is the best right decision for you, your child, and your family right now. It doesn’t have to be a perfect decision to be the best right decision right now. Just do your best – that’s all anyone can do!

To write this article I consulted with John Levitt, Ph.D., an eating disorder therapist who has been in the field for more than 40 years. “Treatment centers represent a lot of money and a lot of time, and a lot of heartache and concern for your child,” he says. “You definitely want to make sure that you understand your options.”

Why send your child to an eating disorder treatment center?

I’ll give you the questions to ask an eating disorder treatment center. For now, let’s start with the reasons why you might be considering an eating disorder treatment center for your child. Here are the top three reasons I hear:

1. Your child is in danger. You have the help of professional dietitians, doctors, and therapists, but there is no reduction in the behaviors. Despite your best efforts and professional care, your child is in serious physical and/or emotional danger.

2. You don’t know what to do. You feel overwhelmed by your child’s eating disorder and simply don’t know what else to do. It seems like a treatment center is the only choice. 

3. You are burnt out. You have been working hard to stabilize your child’s behaviors. You’re driving all over town to appointments, and facing endless arguments and stress over meals. At this point, you are overwhelmed and frustrated by the disorder. You have reached the end of your rope

I support parents who are facing one or all three of these conditions. And I see eating disorder treatment centers as one tool in the toolbox of recovery. They are definitely an option to address these issues.

The benefits of an eating disorder treatment center

“Treatment centers are places where your child can stabilize their eating disorder symptoms,” says Levitt. “Their weight will hopefully improve and likely stabilize. And their eating disorder symptoms will likely be reduced or even eliminated completely while they are staying at the treatment center.”

This is very good news! The main benefits of an eating disorder treatment center are: 

  • Medical and psychological stabilization
  • Your child will be assessed and monitored
  • They will feed your child regular meals and snacks
  • Your child will be physically safe and prevented from acting on purging and self-harm behaviors
  • They will provide activities and skills training to support recovery

A treatment center is ideally a safe place to get into remission from eating disorder behaviors. Your child will most likely be stabilized and make some progress toward recovery. 

The drawbacks of an eating disorder treatment center

One of the benefits of treatment centers is that your child is stabilized in a safe environment. But a drawback is that eating disorders develop in the outside world. So returning home after treatment can sometimes trigger a relapse. 

“Even if the eating disorder behaviors and symptoms get under control in a few weeks or months, there may be many more months, or even years, required to achieve remission and, ideally, full recovery,” says Levitt. “When they get home, they are faced with the same life stressors and conditions that were associated with the eating disorder prior to going to treatment. Home is where the true treatment begins. Your child needs to learn to live with a sense of self-worth and self-efficacy that is enduring and resilient across people, places, and situations, and they often won’t find that in a treatment center. You just can’t practice all of the requirements of life in a controlled setting. Full treatment does not happen in a program, it happens in life.”

In addition to the fact that there will still be work to do when they get home, there may be other drawbacks. I’ve interviewed many people who have spent time in treatment centers, and some of their complaints include:

  • It felt abandoned, isolated, and/or traumatized
  • Inadequate treatment and support
  • Being scared by/not liking the other residents
  • Developing unhealthy relationships and learning new behaviors from other residents
  • Feeling controlled and dominated
  • Not liking the staff and therapists

These drawbacks aren’t meant to discourage you. And many treatment centers actively try to counteract these drawbacks. But it’s important to consider them as you weigh your options.

Questions to ask an eating disorder treatment center

“Treatment centers are run by good people who are generally doing good work,” says Levitt. “That said, treatment centers are businesses, and you as parents are the consumers. Don’t be afraid to be a smart consumer. Ask a lot of questions. Ensure you understand what you are getting into. That is, make sure you know what you will be paying for and what outcomes you can expect. Parents should become the experts on what they are “buying” before taking the leap to send their child anywhere.”

It’s best to interview treatment centers before making a commitment. Here are some questions to ask:

  • What is your treatment approach? On what evidence is your treatment approach based? What is the data suggesting the effectiveness of your program?
  • Specifically, how do you treat people with my child’s type of eating disorder? What is the general treatment plan/approach?
  • How long does it usually take to stabilize a child’s eating disorder, including issues related to mood etc.
  • What is the daily schedule, and who specifically will be working with my child?
  • Can I see my child’s clinical team’s credentials and interview them?
  • In addition to the clinical team, who else will be working with my child? What are their credentials?
  • How do you control for the fact that sometimes eating disorder treatment clinics are learning opportunities for how to become better at eating disorder behavior? What control systems do you have in place to avoid this?
  • What is your success rate in terms of full recovery after a person leaves the treatment center? What are your extended outcomes? What is your relapse rate?
  • How do you involve parents in treatment? What are we to do while the child is in treatment?
  • How will you ensure that I am an essential part of the treatment, and how will you prepare my child, and the parents, for the child’s return home?
  • What will my child need following their stay at the center?
  • How will you know when what you’re doing with my child isn’t being effective? If such a situation were to arrive, what are the alternatives?
  • How do you ensure that a person who goes through your program is successful beyond the program?
  • How much does treatment typically cost? How much is usually the parent’s share of costs? What happens if we are unable to afford the treatment or continued treatment?

“You should not receive vague answers to any of these questions,” says Levitt. “Because they are critical to efforts to achieve full recovery.”

Download The Questions

You can download a free PDF with these questions and other notes you can use to guide your evaluation of an eating disorder treatment center.

Free download Evaluation Sheet For Eating Disorder Treatment Center

What about the cost of eating disorder treatment centers?

Of course your primary concern is your child’s health. And your child’s health is priceless. That said, treatment centers are very costly, which is why you want to be a smart consumer here. Not because you are nickel-and-diming your child’s health. Not at all. But because this is a major commitment and it makes sense to ask questions. 

I wish treatment centers had a 100% success rate. But the truth is that eating disorders are complex and challenging to treat. And residential treatment is typically just one step on the path to recovery. So it pays to be a thoughtful consumer.

“Don’t be afraid to ask about the costs involved,” says Levitt. “Many treatment centers are running 60 days. That’s a long time for your child to be away from home and away from school. It can also be about $60,000 plus. That doesn’t take into account post-center treatment. That can be equivalent to your child’s college tuition.”

The point here is to ask questions. Of course if your insurance company will cover everything that’s a different situation. But if the cost of treatment will fall on you and impact other financial goals that you have for yourself, then weigh the costs and benefits as clearly as possible. 

Making a decision

I wish there were a simple answer to whether to send your child to a residential treatment center and which one to pick. This is something many of my clients grapple with. And the truth is that it’s a difficult decision to make. In the end, the best you can do is do your research and make the best choice you can right now. 

Remember: it doesn’t need to be a perfect decision to be the right decision for you at this moment. Your best decision may be to send your child to residential treatment. And also, it’s OK if that doesn’t feel right for you right now.

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

The quotes from John Levitt, Ph.D. are from a series of articles published in 2017 including this one.

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A parents’ guide to understanding OSFED

A parents' guide to understanding OSFED

Arianna had an eating disorder for a few years before getting a diagnosis. “It’s all so obvious in hindsight,” says her mom, Renee. “She had all the classic symptoms of an eating disorder except she didn’t look like she had an eating disorder. I just didn’t know what to look for.”

Renee’s not the first parent to miss an eating disorder due to the biases and assumptions that drive our cultural understanding of eating disorders. Most people assume that an eating disorder has a “look.” But in fact, the majority of eating disorder diagnoses are not for anorexia. They’re for Other Specified Feeding and Eating Disorders (OSFED). This guide will help you understand OSFED, a serious and often-missed eating disorder.

OSFED is the most common eating disorder. The symptoms cause significant distress but do not fit into the strict criteria for anorexia, bulimia, Avoidant and Restrictive Food Intake Disorder (ARFID), or binge eating disorder.

The advantage of a catchall OSFED category is that people can get a diagnosis for an eating disorder even if they don’t meet the narrow criteria for other disorders. The drawback is that even though it’s very common, few people outside of the eating disorder community know what it is. It also means that people who have very different symptoms get grouped together in a category despite needing very different care.

Exploring weight bias in eating disorder treatment

Among other things, OSFED is used to categorize people who meet all the criteria for anorexia except low body weight. Anorexia is the only mental disorder that carries BMI criteria. To get diagnosed with anorexia you must have a “significantly low BMI.” But BMI is a population tool that was never meant to be used to determine individual health. 

BMI (body mass index), which is based on the height and weight of a person, is an inaccurate measure of body fat content and does not take into account muscle mass, bone density, overall body composition, and racial and sex differences.

Medical News Today

The problem with BMI as a diagnostic for an eating disorder is that if someone was born and has lived their life in the 100th percentile for weight and drops to the 50th percentile, they are very ill, but they don’t technically have a “significantly low BMI.” 

Assumptions about weight and eating disorders can slow down diagnosis. That’s what happened to Renee. “I saw all the signs of an eating disorder,” she says. “She was restricting her food, and definitely over-exercising. I could tell she had a negative body image, though she didn’t talk about it with me very often. But when I tried to talk to her pediatrician about it, the doctor was so pleased about Arianna’s weight loss and fitness routine that he brushed me off.”

Renee is not alone. Many parents who talk to doctors find themselves frustrated and feeling dismissed because their child doesn’t fit the criteria for anorexia or bulimia. Nonetheless, they know that something is wrong. They suspect an eating disorder, but the fact that few people know about OSFED gets in the way of diagnosis.

OSFED: a misunderstood eating disorder

OSFED is poorly understood and recognized in our culture, yet it constitutes the majority of eating disorder diagnoses. When it was called by its previous name, EDNOS, more than half of all patients seen at eating disorder treatment centers were in this catchall category. 

Since OSFED is a broad category, it is often misinterpreted as being less serious. But studies have shown that people with OSFED experience eating pathology and medical consequences that are just as severe, often even more severe than those who are diagnosed with anorexia or bulimia. 

In fact, one study found that 75% of people who were diagnosed with EDNOS (now called OSFED) had comorbid psychiatric disorders and 25% had suicidal thoughts. Professionals say that people who are diagnosed with OSFED need the same level of treatment and support as those with anorexia or bulimia. And untreated OSFED often leads to a future diagnosis of anorexia, bulimia nervosa, or binge eating disorder. 

A lack of understanding

Renee kept pushing for answers, and Arianna was diagnosed with OSFED about a year ago. Aside from the delay in treatment, Renee is frustrated by friends and family who don’t understand. “It’s really invalidating when my friends assume that because she doesn’t have anorexia or bulimia it’s somehow not serious,” she says. “And if I feel invalidated, I can only imagine how she feels!” 

Most people assume that when someone has an eating disorder it must be anorexia. But less than 6% of people with eating disorders are medically diagnosed as “underweight.” If parents and loved ones only think of eating disorders as having the look of emaciation, we risk under-diagnosing and under-treating the majority of eating disorders.

Weight is a very tricky element of eating disorder diagnosis and treatment. Parents can’t assume that a child’s weight alone is a sign of health or illness without careful evaluation of emotional and behavioral symptoms that will more reliably indicate an eating disorder. That’s why I created this guide to OSFED, a poorly-understood eating disorder.

One key is to recognize the behavioral and emotional signs that typify most eating disorders.

Behavioral symptoms of eating disorders

Here are the behavioral symptoms that commonly cross across all eating disorders: 

  • Different eating behavior, particularly skipping meals, eating less in public, sneaking food, lying about food, etc.
  • More emotional outbursts like yelling or crying, or emotional withdrawal
  • Marked changes in social behavior like being more or less socially active, getting a dramatically different friend group, etc.
  • Body checking and monitoring with a scale, mirror, reflective surfaces, etc.
  • Wearing tighter or looser clothing and/or changing outfits frequently because nothing seems right
  • Talking about their body and other people’s bodies, what they’re eating, what they weigh, etc.
  • Sudden interest in “health” foods, nutrients, carbs, sugar, and fat
  • Increased exercise and a lack of flexibility about exercising (e.g. I have to exercise to feel OK)
  • More interpersonal conflicts and social isolation

Emotional symptoms of eating disorders

Here are the emotional symptoms of most eating disorders:

  • A tendency towards perfectionism and/or binary (black and white) thinking patterns
  • History of trauma
  • Anxiety and/or depression
  • Lack of emotional regulation skills to manage feelings of stress and anxiety
  • A sense of being different or “other” 
  • People-pleasing
  • Low self-worth
  • Strong desire to be “good” as defined by society
  • Defensiveness, particularly when confronted about unusual eating behaviors
  • Irritability and moodiness

Even if your child never meets the diagnostic criteria for an eating disorder, these behavioral and emotional signs are enough to warrant therapy. This can help prevent a future eating disorder.

What to do if you suspect OSFED

This guide will help you spot whether your child has an eating disorder and understand OSFED in particular. If you suspect your child has an eating disorder, please follow these steps: 

  1. Take a deep breath, and remind yourself that this is hard, but you can handle it. Your emotional reaction is understandable, but you’re going to need a lot of self-compassion to get through this.
  2. Contact your child’s physician and have them physically evaluated to check for any physical symptoms of an eating disorder.
  3. Schedule an appointment with a therapist and/or dietitian who specializes in eating disorders. These are people who are trained specifically to diagnose and treat eating disorders. Particularly with OSFED, you want an eating disorder specialist, not a general therapist or dietitian.
  4. Educate yourself by learning as much as you can about eating disorders in general and your child’s specific symptoms.
  5. Find out how you can change your own home environment to support your child’s recovery. Eating disorders are highly responsive to social environments, so you will need to make changes to foster change.

Catching up with Renee

Renee says that Arianna is doing well with treatment. “I wish we had started earlier, but I’m also glad I pushed so hard for the diagnosis,” she says. “She’s actually been doing really great, and our whole family has adjusted to support her mental health. It’s made a difference for all of us. We’re all feeling better these days!”

I know that having a child with an eating disorder is hard, and I hope this guide to OSFED is helpful.

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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

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Coach your child to eating disorder recovery

How to coach your child into eating disorder recovery

Ian and Melissa were stunned to find out that Jake, their son, had an eating disorder. “We didn’t see it coming at all,” says Ian. “I thought he was really applying himself to his fitness and sport, but now I can see that his behavior became more and more disordered over time.”

Ian is a high school coach, and while he doesn’t coach at Jake’s school, there’s still a lot of overlap. “I’ve been coaching Jake since he was born, practically,” he says. “I love taking him out to throw the ball and practice his swing. We’ve been playing baseball his whole life. And now he can’t play until he gets better. I don’t know what to do with him anymore.”

Melissa agrees. “It’s like our whole life revolved around baseball – Ian’s and Jake’s, and now we’ve had to change everything,” she says. “Jake can’t play, and Ian doesn’t know how to connect with Jake without talking about baseball. It’s created a double problem. There’s the eating disorder, but then there’s also the loss of this connection they had.”

I get it. Making the transition from feeling as if everything is on track to dealing with an eating disorder is a major shift. But the good news is that Ian’s background as a coach can be really helpful in eating disorder recovery. While they’re taking a break from baseball, he can use his coaching skills to connect and support Jake through recovery.

Here are six skills Ian can use to coach Jake through recovery from his eating disorder.

1. Know your role 

A coach has played the game and honed their skills over years of practice. But the best coaches aren’t always the best players. Because being a coach is very different from being a player. The key difference is that a coach recognizes and honors their players’ autonomy, knowledge, and strengths. 

A coach can’t get on the field and play the game. Instead they help their players do it. A coach’s responsibility is to guide, not to control. They provide support, insight, and knowledge, but never lose sight of the fact that the person they are coaching is responsible for making his or her own decisions. 

This is a great model for parenting through an eating disorder. Just like a coach, Ian can’t do recovery for Jake. But he can support Jake nonetheless. And his support will be invaluable to Jake’s recovery. Knowing his role will help him embrace what he can do to help.

2. Know the game 

A great coach knows the game inside and out. Just because you don’t currently know everything about eating disorders doesn’t mean you can’t be a great coach. But it does mean it’s time to learn. Learn about eating disorders, then, learn about your child’s own unique form of disordered eating and over-exercise. No two eating disorders are the same. 

Get to know more about your child’s co-occurring and underlying problems, such as anxiety, depression or ADHD, ASD, OCD, PTSD, etc. Learn about what is going on by reading, talking to others, and researching everything you can to help you better understand your child’s mental health.

Ian feels out of his element with eating disorders, but that doesn’t mean he can’t become an expert on Jake and his eating disorder. He can apply the same time and passion that he’s dedicated to baseball to this.

3. Ask questions

A good coach asks a lot of thoughtful questions and provides few answers. Coaches know that a great question can open up new ideas and opportunities for a player. When coaches have all the answers, the player doesn’t “own” their own game. But when a coach asks the right questions, the player takes responsibility for their performance and plays better as a result.

When working with your child, ask questions that allow your child to find out more about him or herself. Talking through problems without having your offer advice and guidance (unless expressly requested), will help your child find their own solution. When someone finds their own solution, they are more engaged in the outcome. 

Also ask questions of your child’s treatment team, not just at the beginning, but constantly. Never be afraid to ask about progress and the system the therapist is following towards recovery.

4. Listen carefully

Coaches must listen carefully and reflect back what they are hearing. During this process, the coach allows the other person to work out what they are really trying to say or do. A coach is both authoritative and humble. Coaches know their stuff and aren’t afraid to show it, but they also honor each player’s autonomy and empower them by treating them with respect.

Be humble enough to recognize that you do not know your child’s thoughts based on the simple fact that you are their parent. In fact, there is a very good chance that the fact you are a parent is making it impossible for you to guess at what your child is going through. 

When you learn to listen actively and supportively without judgment or opinion, your teenager will surprise you with how much they have to say. This is not easy, but it makes a huge impact.

5. Be organized

A coach comes to the table with an idea of what they want to accomplish with each player. Coaches know the skills their players need to succeed and are experts at recognizing who needs to work on what. Structuring practices so that everyone works on the skills they need requires organization and planning.

Talk to your child’s treatment team and find out what skills they are currently working in therapy. Ask for ways to reinforce that skill at home, and then work as a family towards that goal. 

Talk to your child about their own goals during recovery. What are some important milestones that you can help them work towards? Not all of the goals have to be about the eating disorder – life goals are just as, if not more important during recovery. Being a great coach through eating disorder recovery is a combination of organization and inspiration.

6. Leave your ego at the door

A coach must put the outcome – success or failure – in the hands of the player. A coach cannot get out on the field or force someone to achieve great results. Because great results must come from the player. 

Your child will only fully recover if they can find a way to be self-motivated. Coaches help players tap into inherent motivation by leaving their egos at the door. Coaches must disengage their success from that of the person they are coaching. Your child is not a reflection of you. Your child is a human being who needs to find his or her own way in the world.

Great coaches are not born, nor are they made overnight. The best coaches spend decades learning how to achieve the six points above. They learn through trial and error, research and deep reflection. 

Ian and Melissa don’t have decades to work with. But they have a lot going for them as loving, caring parents. And they can coach Jake through eating disorder recovery by attending to these six coaching concepts. Since we’re talking about their kid, for whom they’re willing to move mountains, I know they can do a lot to help. 

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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Is it sugar addiction, an eating disorder, or something else?

Is it sugar addiction, an eating disorder, or something else?

Brandon has been worried about his son Michael for a few years. “He’s always been really into sugar, sweets, and junk food,” says Brandon. “I’ve tried to tell him he needs to avoid sugar. Telling him it’s bad for him doesn’t change anything. I’ve tried hiding the sweets, not buying sweets at all, and even punishing him for eating too many sweets. It seems like sugar addiction, or is it an eating disorder?”

I can understand where Brandon is coming from. There’s a lot of fear about sugar right now. In fact, there’s a lot of common knowledge saying that sugar is a direct cause of disease and weight gain. But the first thing to know is that scientifically sugar is a causal factor in tooth decay, but it is only correlated with other health issues. The truth about sugar is complex and nuanced. 

But the media hates nuance and loves a bad guy, and sugar is it right now. Most of us parents were raised to fear fat, but sugar has taken over as the new nutritional evil. Imagine if we’d heard about a butter board in 1998! The horror! Meanwhile, our “healthy” Snackwells fat-free cookies were loaded with sugar. Nutrition is subject to trends, so it’s a good idea to keep this in mind every time we meet a new nutritional bad guy.

It’s a matter of degree

Look, nobody’s saying we want our kids to eat only sugar all the time. That doesn’t make any sense. But there’s a huge distance between banning sugar and eating only sugar all the time. And that’s what I want to explore with Brandon. Just how often is Michael eating sugar? What’s happening when he eats sugar? Let’s tease this apart a little bit.

“I guess he eats sugar a few times a week,” says Brandon. “Since I rarely have sweets, cookies, and candy in the house now, it’s definitely a special occasion thing. For example, after baseball practice they always get a snack, and it’s often cookies or something like that. And of course there are birthday parties and family events. Stuff like that.” 

Brandon has banned sugary foods from the house. It sounds like he’s concerned about how Michael responds when he gets access to it out of the house.

“He goes crazy for the cookies,” says Brandon. “I see him taking more than his share and it’s embarrassing. And at family parties when there’s a cake, he’ll have two or three slices if I don’t stop him.” 

Got it. So the big question for Brandon is whether this is a sugar addiction or an eating disorder or something else. 

Is sugar addiction real?

I checked in with registered dietitian Marci Evans to find out more about sugar addiction. “I’ve been carefully watching the science of food addiction for years,” she says. “And aside from the fact that the “news” about sugar as an addictive substance sounds a lot like fear-mongering to me, it also doesn’t square with my clinical experience as a dietitian. My quick answer is that I don’t believe that sugar is addictive in the same way as caffeine, alcohol, tobacco, cocaine, and other substances.”

Many dietitians, especially those who work with eating disorder populations, are deeply uncomfortable with the vilification of sugar in our culture. They don’t agree with the idea of sugar addiction. And they worry that fear of sugar can lead to an eating disorder.

“I think that the biggest issue with sugar is that, like everything, once a human is told that something is “off limits,” our brain kicks into deprivation mode,” says Marci. “I frequently hear people talking about food, including sugar, and telling me they feel as if they are addicted, by which they mean they feel they cannot stop themselves, and they would really like to stop. It’s important to note here that someone feeling as if they are addicted to something is not the same as being physically addicted to something.”

The body’s need for food is a biological necessity. The drive for food – including sugary food – is not the same as a drive for optional substances like alcohol, tobacco, and cocaine. Putting sugar in the same category as these substances is chemically inaccurate.

A behavioral addiction

But it’s also true that food can feel addictive. Behavioral addictions are an obsession with and compulsion to do a certain behavior. And eating can certainly become a behavioral addiction. But it’s important to separate behavioral addictions from substance addictions. This is because the treatment for substance addictions usually involves not taking the substance anymore. But most behavioral addictions require at least some continuation of the behavior. 

For example, an eating disorder may be viewed as a behavioral addiction. But recovery is not about never eating or always eating. It’s about finding balance in your approach to the behavior of eating. Recovery from a behavioral addiction is not about abstinence, but acceptance and modulation of urges and desires.

“So far, there is absolutely no scientific evidence that any food is addictive,” says Marci. “Humans must eat food to survive. No specific compounds have been found in food that are like the compounds found in drugs and alcohol. The human drive for food is considered adaptive, while the drive for addictive substances is considered maladaptive.”

What about the rat studies?

“But what about the research showing that rats get addicted to sugar?” asks Brandon. 

“There has been research showing that rodents consume sugar in an “addictive-like” way,” says Marci. “But this only occurs in settings that involve sugar restriction. This is critical because it is the reason I don’t promote restricting any food items, including sugar. When rats are kept in captivity and offered sugar on an intermittent basis, they exhibit binge-like eating, which researchers identify as addictive behavior. However, when the rats are offered sugar constantly, they do not exhibit this behavior, nor do they eat excessive amounts of sugar.”

“From my perspective, the study of the rats actually supports not vilifying sugar, since doing so can lead to binge behaviors that may look and feel like an addiction,” says Marci. “Again, there is no proof that this behavior is based on the substance itself, but rather the restriction of the substance.”

Ah! That is the key here. 

Sugar is compelling

Sugary foods are delicious and compelling for most people, especially children. But there are plenty of children and adults who eat sugar regularly without any signs of addiction or disordered eating. And the secret is that these people are allowed to eat sugar regularly. Without restriction, sugar is delicious, but it’s not compelling. It’s not an obsession or compulsion. We’ve seen this with rats. And dietitians who practice the Ellyn Satter method and/or Intuitive Eating see it every day, too. 

We’ve all seen the kids who dive for the cookies or brownies at the party. What makes them different from the kids who could take it or leave it? Usually it’s the amount of sugar restriction they’re experiencing at home. Because kids who have access to cookies regularly are not likely to feel obsessive, compulsive, or addicted to cookies. 

“Higher weight and binge eating disorder, both of which are frequently associated with “sugar addiction” are far more complex than any single food item,” says Marci. “What I see clinically is that food restriction is a more significant problem and a precursor to weight gain and eating disorders than sugar.”

Advice for Brandon

I can understand why Brandon is concerned about sugar addiction and the potential for an eating disorder. But Michael’s excited behavior around sugary foods is most likely being driven by restriction. We can’t rule out an eating disorder. But we do know that restricting foods at home is a risk factor for eating disorders. So I have some advice for Brandon: 

1. Relax the rules

First, relax your at-home rules around sugar. Remember there is a huge space between no sugar and only sugar. Introduce dessert occasionally or even every day and start normalizing sugary foods as part of a balanced diet. That’s right: sugar can be part of a very healthy diet. Incorporate sugar into your regular diet. This will remove the sense of restriction that may be driving the addicted-like behavior you’re seeing in Michael. 

2. Add in more nutrients, structure, and pleasure

Next, focus more on what you add than what you take away. I’ve said to incorporate sugary foods, but also seek ways to add in more nutritious foods. Expand your family’s daily intake of whole grains, nuts, seeds, fruits, and vegetables. Now, add in is more structure around food and eating. Many families lack feeding structure. But structure has been shown to have a much greater impact on lifelong health than any diet. Do you have at least one family meal per day? If not, add that in! Finally, add in more pleasure! Eating is a social behavior in human beings. Enjoy food, enjoy eating, and enjoy each other.

3. Talk about balance

Once you’ve had sugar incorporated in your diet for a while, if Michael is still acting like he’s “addicted” to sugar, talk about specific behaviors you’re seeing. Make sure you’re coming from a neutral, non-judgmental standpoint. Michael may need help noticing that he is taking more than his share at practice. And maybe one piece of cake at the party is totally OK. But then he could add in something with greater nutritional value and then re-evaluate whether he wants a second slice. These conversations will go much better if you’re already modeling this behavior with sweets at home.

4. Stop food shaming

Finally, stop food shaming and any negative talk about food. All foods fit in a healthy diet. Brandon loves Michael and wants what’s best for him, but badmouthing food and calling it junk makes it feel restricted. We crave foods when they are restricted. When all foods are allowed, they are no longer worthy of obsession and compulsion. And never punish a child for eating. When you punish a child for seeking comfort and joy in food you support a disordered relationship with food that can have a lifetime impact on health.

Up for the challenge

It’s a lot to take in, but Brandon seems up for the challenge. “I can relate most of all to the kids who don’t get sugar at home grabbing all the cookies when they have a chance,” he says. “I remember kids like that when I was growing up. This one kid was on a really strict diet at home and he was seriously crazy about food. Give him access to pizza or M&Ms and he was all over it. The rest of us knew it was because he didn’t get it at home. I guess I’d forgotten about that until right now.”

Brandon’s going to give this advice a try and watch carefully for a reduction in the symptoms of sugar addiction and an eating disorder. Then we’ll re-evaluate whether there’s something more serious going on for Michael.

This is an update to an article published March 13, 2018 called “But, seriously, my kid is addicted to sugar. A discussion about sugar addiction with dietitian Marci Evans”

Marci Evans, MS, CEDRD, LDN, has dedicated her career to counseling, supervising, and teaching in the field of eating disorders. She is a Certified Eating Disorder Registered Dietitian and Supervisor, certified Intuitive Eating Counselor and Certified ACSM personal trainer. In addition to her private practice and three adjunct teaching positions, Marci launched an online eating disorders training for dietitians in 2015 and is co-developing a specialized eating disorder internship at Simmons College.

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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

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What purpose does an eating disorder serve?

Meaning, purpose, and eating disorder recovery

Bridget’s daughter Sadie has an eating disorder. “It’s so hard to watch her,” says Bridget. “It seems as if her entire purpose in life has become her body. I can’t understand why this happened. I’ve never taught her or modeled that her body is this important. So why is this happening?”

Bridget’s concern and confusion make sense. It’s upsetting when a child finds purpose and meaning in an eating disorder. From the outside, an eating disorder seems destructive and harmful. So why do kids like Sadie find comfort and purpose in managing their bodies like it’s the most important thing in the world?

The answer is complicated. There is no single reason why an eating disorder shows up. However, it’s not uncommon for eating disorder beliefs and behaviors to add meaning to a person’s life. Seeing eating disorders as purely destructive interferes with our ability to understand and treat the disorder. When we understand the purpose, we can address it.

💥 Note: an eating disorder may serve a purpose, but an eating disorder is not on purpose. 💥

Meaning, purpose, and eating disorder recovery

Like all of us, kids like Sadie are seeking meaning and purpose in life. It is human nature to seek purpose, and in our individualistic culture, it’s all too easy to turn our sights on our bodies as a worthy purpose. 

But when your own body becomes your purpose, things can get a bit messy. This is what we see with eating disorders. 

Purpose is our reason for being, the thing that gets us out of bed in the morning, the thing that lights us up. Purpose is usually about something larger than ourselves. We are communal creatures, and thus purpose usually revolves around community. Each person’s purpose is different, but we do know that all people seek purpose and meaning in their lives. 

But sometimes our kids can’t find a purpose. And between COVID, school shootings, the news, and everything that’s been going on in the last decade in our society, many kids are feeling overwhelmed and lack hope. And without hope, it’s hard to find purpose.

So sometimes an eating disorder can come in and fill the need for purpose in a person’s life. It can fill a hole and give a person a reason for living. And I know it doesn’t seem like an eating disorder is a worthy purpose, but it may be the best way they can get through the day right now. 

Of course parents would like to see their kids seek purpose outside of their bodies. And we definitely want kids to seek purpose outside of their eating disorders. But it’s very hard to turn the tide when you don’t know what you’re looking at. Here are some examples of how purpose can get wrapped up in eating disorder behaviors: 

Weight control

Most eating disorders begin with a goal to lose weight. Our culture is obsessed with diet and fitness, and harmful diet messages are everywhere. Our kids pick up on the importance of staying small from a very early age. Doctors, teachers, and the media all promote weight control as essential. Weight control can feel like a very worthy goal in our culture even if it’s not coming directly from the parents.


Binge eating disorder, bulimia, anorexia, and eating disorder not otherwise specified (EDNOS) typically involve the core behavior of restricting food and the belief that doing so will result in a thinner body. Restricting food can feel powerful and strong even if the result is the opposite. Overcoming physical urges can become a compulsion because it gives a sense of control and mastery.


Eating disorders may provide hope. Hope that, in this overwhelming world, at least we can control our bodies. Hope that we can succeed at restriction or achieve a certain weight. Hope that life will be better and more fulfilling if we can meet the body ideal and/or control our actions. Hope that manipulating eating and exercise will bring happiness.


In addition to promoting thin bodies, our culture also promotes strength as an important virtue. We all want to feel strong and powerful in life. An eating disorder can come in and show someone they are strong enough to resist eating food. Strong enough to keep running even when exhausted. Strong enough to force food out of their body after it’s been consumed.

Eating disorders often serve a purpose in someone’s life. They provide important benefits that can be hard to see but are nonetheless powerful. Treating an eating disorder without addressing the purpose it serves in someone’s life can lead to incomplete recovery.

Finding purpose outside an eating disorder

Your goal should be to support your child in finding joy and purpose outside of their eating disorder. Generally, a good purpose has something to do with being part of something larger than yourself. Here are some examples of broad categories that might appeal to your child:

  • Social justice
  • Animals
  • Nature
  • Entrepreneurship
  • Leadership
  • Caregiving
  • Community
  • Athletics (With a focus on camaraderie and connection rather than individual performance)
  • The arts

Once your child has a general idea of what they might be interested in, you can help them nurture their purpose in the following ways: 


An eating disorder is typically a disembodied experience. Denying hunger, counting calories, binge eating, over-exercising, and purging require a separation of mind and body. Having a mindfulness practice will help your child develop an awareness of their needs and desires, which is essential to finding purpose. I really like the Wheel of Awareness program from Dr. Dan Siegel.


When a child finds purpose in their eating disorder, they are applying their valuable skills and resources to their own personal body project. Help your child find a place to volunteer their time, energy, and talents. This will build their sense of community and help them see how applying themselves to others is more fulfilling than focusing on their own body. 


Help your child explore their natural and instinctive passions. One problem is that often we start with a natural passion and quickly turn it into a career goal. For example, did they like to sing until they turned it into a passion for being a rock star? Scale it back and just enjoy the passion of singing without tying it to an outcome. The lack of talent or future financial success is no reason not to enjoy a passion.


Finding purpose is usually rooted in social connection and the greater good, so finding a community to belong to can be a great start. Help your child find a community where they feel they belong and are contributing to the group. Look for school clubs, community groups, sports or arts, or anything else that brings like-minded people together.  


Of course you want your child to have a purpose beyond their eating disorder. So how are you feeling about your purpose? Do you have a vision statement for yourself? What gets you up in the morning? Start talking with your child about your purpose, and if you aren’t sure what it is yet, talk about that. Telling our kids to find a purpose will be much more powerful if we’re modeling how to do that and talking about the benefits in our own lives.  


Purpose can’t be rushed. It took time for your child to develop an eating disorder. And it will take time for them to replace their eating disorder with healthier pursuits. When it comes to purpose, it’s often a slow and steady process rather than a single event or declaration.

Getting started

Bridget listened to this advice and realized she had to start with herself. “I’m embarrassed to admit that I don’t think I’ve worked on this for myself yet,” she says. “I’ve been so focused on Sadie having a purpose and I guess I forgot that these things have to start with me. Maybe it’s not so much that I taught her that her purpose is her body, but that I didn’t show her how to build a purpose.” 

Bridget spent some time coming up with the things that light her up and started participating in activities that helped her make progress on her purpose.

Bringing it to Sadie

Once she was working on her own purpose, Bridget started to have conversations with Sadie about her purpose. It’s been challenging at times, but overall Sadie has been surprisingly open with the idea of finding purpose outside her eating disorder. She has roughly identified that nature might be an area of interest for her and is slowly exploring possibilities.

“I think the biggest breakthrough has been in thinking about this differently,” says Bridget. “Before I was very much focused on getting Sadie to change. But now I’m really working on making changes in myself and our family. And I notice that Sadie is a lot more open to trying things and exploring her purpose with this approach. We’re still dealing with the eating disorder, but I feel much more hopeful today than I did before we started this.” 

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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

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A toolkit to cope with anxiety when your child has an eating disorder

A toolkit to cope with anxiety when your child has an eating disorder

Jamie feels helpless and frustrated. Her son Michael has an eating disorder and severe anxiety, and the combination is making life very hard for them. “I just want to be able to do things that other families do without thinking about it,” she says. “Like go to a restaurant or the movies without all the drama of the anxiety.”

I get it. Anxiety is stressful for everyone, and many parents feel helpless when anxiety shows up and takes over. This article will help you cope with anxiety when it shows up alongside an eating disorder.

Anxiety is a major underlying and co-occuring factor with eating disorders. And anxiety is on the rise for our tweens and teens. A study by the American College Health Association found a significant increase. Up to 62% of undergraduates reported anxiety in 2016, up from 50% in 2011. A more recent study conducted by the Health Resources and Services Administration (HRSA) found that between 2016 and 2020, the number of children ages 3-17 years diagnosed with anxiety grew by 29%.

Anxiety impacts almost every aspect of life. But anxiety is also a very treatable disorder. Things can get better! You can help by teaching your child to cope with anxiety when they have an eating disorder.

Coping tools for kids who have anxiety and an eating disorder

Anxiety disorders are hard to cope with, especially if they occur in conjunction with an eating disorder. Therapy for anxiety typically includes Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). These treatments are designed to teach kids coping mechanisms and new thought patterns to get through anxiety.

If your child has an eating disorder, they should be receiving therapy to help them manage their anxiety. But some tools can help with short-term coping. While these tools don’t replace therapy, they can be very helpful for parents trying to cope with the stress of everyday living with anxiety and an eating disorder.

The tyranny of surprise

One of the hard things about having anxiety is that it can feel so surprising. Few people think of themselves or their kids as fragile. So we walk around expecting things to be fine. But then anxiety shows up apparently out of nowhere and surprises us. But the thing about anxiety is that it shows up reliably, usually every day. And often there are common threads before the anxiety shows up. We shouldn’t be surprised, and yet most of us are.

One idea is to start expecting anxiety to show up. This reduces the stress and anxiety about having anxiety. 

Parents can say things like “oh, here’s anxiety, I expected it, welcome anxiety!” Doing this takes some of the power away from anxiety. And it helps your child feel less vulnerable to its impact. When parents normalize and accept anxiety, it often feels less intense for everyone. 

That’s why I love using anxiety props and tools. They’re a great way to show that not only do you expect anxiety to show up, but you are also prepared for it and have your response ready to go. 

Build an anxiety toolkit 

I think it’s helpful to have some props or tools to cope with anxiety because it gives a visual and action-oriented response that shows you are not surprised or upset when anxiety appears. You can have one or two of these items available or even develop an “Emergency Anxiety Kit” with a few different options when you’re on the go. 

Talking with our kids about anxiety and discussing soothing tools that may help is important. Not every child responds similarly, so I have provided several options and ideas. Generally, we’re looking for tools that engage the senses. This helps ground the anxiety by responding neutrally when it shows up and stimulating the body’s five senses. 

Help your child find the tool or tools that help them get grounded during an anxiety episode. Here are some ideas:

1. Counting beads (touch)

Counting is very effective in soothing the mind during an anxiety episode. Many people who struggle with anxiety learn to look around and start counting items to help their brains regroup. This is a form of mindfulness. A good place to begin is with counting beads. You can get small beaded bracelets, (also called a prayer bracelet), which they can use to count silently.

The combination of touching the beads and counting can be very soothing. Your child may prefer one type of bead over another. Thus, it can help to test a few out if possible. The best part about beads is that they can be kept on the wrist or in a pocket. And it helps that they can be touched or counted without anyone knowing. 

2. Stress slime (touch)

Touching something during an anxiety episode can be very therapeutic, since anxiety often becomes trapped energy in our bodies. Slime can be a great way to provide our kids with a tactical outlet for their anxious energy. You can buy slime online. There are many types, including slime with styrofoam beads and other items that add to the tactile pleasure that slime provides.

You can also make slime using one of the hundreds of online recipes. Experiment with your child to develop different slimes. You can keep them in sealed containers or zip-top baggies so that they are always available for your child to use. 

3. Something soft (touch)

Sometimes there is nothing better than the feeling of something soft and furry when we’re stressed. This is the appeal of stuffed animals, which your child may keep in their room and stroke during stressful periods. Of course, a pet works well with that, too! Fur keychains are a popular trend right now that can be used as soothing tools without detection.

A very simple pocket-sized option to deliver softness is to go to the fabric store with your child and touch the fur and fleece fabrics. Select a few that feel best to your child, and purchase a quarter yard of each. Cut the fabric into pocket-sized squares or rectangles, and replace as often as necessary. Some children will find it soothing just to touch the fur with their fingers. Others may find it helpful to rub it on their arms or faces for soothing relief from stress.

4. Photos (sight)

When anxious, it’s easy to lose touch with our sense of place in the world. Even if plenty of people love us, anxiety can make us forget that momentarily. Kids may become flooded with fear that they will never belong and are all alone in the world. This is why photos can be grounding.

If your child has a smartphone, you can add some photos designed to remind them of the people and animals they love. Or you can print out photos to be kept in pockets or bags. 

For example, a photo of your daughter with her beloved cat can be an excellent reminder of unconditional love and acceptance. If your child has a deep affection for a cousin or extended family member, take a photo of them enjoying something together and add it to the collection. 

5. Music (sound)

Listening to music, playing an instrument, or singing can be a great tool for redirecting anxiety. You can create a playlist filled with songs to soothe anxiety so they can access music anytime anxiety strikes. Classical music is reliable in this way. Some great soothing classical music can be found on Baby Mozart-type albums.

If your child plays an instrument, you may suggest that they learn a piece by heart that they can play in times of stress. Choose something simple enough that they aren’t struggling yet challenging so that they engage their mind a little bit with the music. If your child enjoys singing, you may suggest they assign a favorite song to sing during times of anxiety. Ideally, this is a song to which they know all the words and that is inherently soothing. Lullabies and favorite childhood songs are a great choice.

6. Peppermint (taste/smell)

Studies have shown that people exposed to peppermint oil feel a sense of calm and alertness. When studying drivers, studies have shown that peppermint can reduce frustration, anxiety, and fatigue. The simplest way to get some peppermint into your child’s system is to provide them with some peppermint candies that contain real peppermint oil. They can keep the candies in their pocket and suck on them to help soothe their anxiety.

Another method is to smell peppermint oil. This can be done by adding a drop of peppermint essential oil to a cotton ball and putting it in a zip-top bag that can be kept in your child’s pocket. You can also add peppermint essential oil to slime, or you can make a small clay diffuser that your child can have available as needed.

Learning to help kids cope with anxiety and an eating disorder will help a lot with your child’s emotional regulation. And the good thing is that once you’ve learned it, it gets easier each time. Anxiety is normal – everyone has it. But we want to help our kids who have eating disorders cope with anxiety as best they can. 

Jamie saw a difference as soon as she put together her anxiety toolkit for Michael. “The biggest thing is that I felt like I knew what I was doing and was supposed to do when his anxiety showed up,” she said. “I never realized how stressed I was every time I detected anxiety. Now I feel like I know what to do. And it doesn’t work perfectly, of course, but it has helped us many times when he started to spiral and needed a little help grounding himself.”

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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

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Loneliness and eating disorders: a guide for parents

loneliness eating disorder

Jill is beside herself with worry. Her daughter Melody has an eating disorder and is struggling with loneliness. Between treatment, COVID restrictions, and starting high school, she has become very isolated. “She has always been more on the introverted side,” says Jill. “But it’s gotten to the point where I’m pretty sure she doesn’t have a single good friend.”

“She has people she talks to in class,” says Jill. “But there’s nobody she can call or share notes with or hang out with after class or on the weekend. I think that loneliness is making it harder to recover from her eating disorder. But loneliness is also partly driven by the eating disorder. I don’t know what to do.”

Jill’s worry makes a lot of sense. And she’s right that loneliness is both a contributing factor to and a symptom of an eating disorder. Melody is naturally introverted. But she’s also been hit with a triple whammy: a pandemic, the transition to high school, and eating disorder recovery.

Loneliness and social isolation

Loneliness is a major factor in mental and physical health. In fact, social relationships are the most important lifestyle factor in longevity. Social connections are even more important to health than avoiding tobacco and alcohol. Humans are social beings, and connecting with others is essential to our health and well-being.

How to help a child who has an eating disorder decrease loneliness

Of course parents like Jill desperately want their kids to form social connections and feel a sense of belonging. This is especially important during the teenage years, so it’s understandable that Jill is concerned. But what can she do? How can Jill help Melody reduce her loneliness during eating disorder recovery?

Friendships lead to positive life satisfactionminimize stress, and even contribute to better physical health outcomes. And the good news is that there is a lot that parents can do to support social connections. Here are five places to start:

1. Reduce the pressure

The first thing to know is that every person has a different need in terms of social connections. And while most of us think about a large pack of kids getting together on the weekends, it’s perfectly acceptable if your teenager has just one or two good friends. In fact, set your sights very low: one.

“The biggest return we get in friendship is going from zero to one friend in terms of its impact on our mental health and well-being,”  says Marisa Franco, author of Platonic: How the Science of Attachment Can Help You Make — and Keep — Friends. “If you can get that deep with one person, it’s going to be powerful and it’s going to be impactful, and you don’t need to have a ton of friends.”

Taking the pressure off having a large number of friends can be a great place to start. Find ways to weave this idea into your conversations with your child. You can talk about your own friends individually vs. as a group. And when your child complains about having no friends (plural), help them understand that just one friend would be awesome. Encourage them to look around for just one person at school who they can eat lunch with. Set your sights low, and normalize the idea of just one friend.

2. Family relationships

Your child wants and needs peer friendships, but that doesn’t mean they can’t get a lot of benefits from their social connections with family.

Our first social group is our family. How strong are your family ties? Does your child feel integrated and as if they “belong” to your family? Start by building family traditions and telling stories that help your child see how they fit into the family. Spend time building family integration every single day. A great place to begin is a family meal, which has countless health benefits, probably in part because of the social belonging it builds.

If possible, schedule activities with extended family members. It’s OK if you don’t have a strong connection with biological family – can you build a family of friends? Do what you can to expand your child’s social interactions within the scope of your family. And don’t forget to help them integrate into family activities. This may be uncomfortable if your child is feeling lonely and vulnerable, but parents can help grease the wheels of interaction!

3. Social skills

If your child is struggling with loneliness and an eating disorder, combined with COVID and a major transition like starting high school, they may need to brush up on their social skills. This can be a tricky area for parents to get involved, but the first thing to consider is whether your family is upholding and modeling good social skills.

Many families slip into dysfunctional patterns of not being friendly, not speaking politely to each other, not managing their emotions, and acting out against other family members. If you see these dynamics in your family, then get some coaching or family counseling to work on interpersonal boundaries and emotional regulation. Before you decide that your child is the one who has a problem with social skills, consider whether this is a family dynamic. It will hurt your child’s chances of success if you treat a family problem as if it is a personal failure.

Next, talk to your child about social skills. The easiest way to do this is to talk about your own experiences or use characters on TV and movies. Ask questions like: How would that behavior make you feel? What do you like about that character? How do you think that character could be a better friend? Remind your child that relationships can’t be adequately portrayed in the media, and that just like bodies, we need to take media relationships with a grain of salt.

4. Formal social groups

Teens have undergone tremendous upheaval in the past few years, and lots of them are struggling with loneliness. This is the perfect time to use formal social groups and organizations to help support social development. Ask your child to investigate clubs at school.

Many schools have a wide variety of clubs that appeal to a broad array of personalities and interests, but you can also look for clubs in the community and at your place of worship if you have one.

Encourage your child to join at least one club. This may require some well-placed parental pressure. Someone who is lonely may resist the idea of joining a club because they are stuck in a cycle of feeling low. It’s OK for you to insist on some participation. You can’t force your child to go, but don’t underestimate the power you have to influence them to give it a try. Sometimes lonely kids need a lot of verbal encouragement and requests to get out of their rut.

5. Get help

If you do all these things and your child’s loneliness is not lifting at all, then you and your child need more help. Talk to your child’s eating disorder care team. They are probably as concerned about loneliness as you are. Find out if they have any suggestions or can help your child get involved in activities. Sometimes having a non-parent make these suggestions is the key to getting them done.

A worthy focus

Considering your child’s loneliness during eating disorder recovery is a worthwhile activity. You want to understand your child’s loneliness and support them in feeling better. Loneliness has been correlated with eating disorders and other mental disorders. It is also correlated with the No. 2 and No. 3 mortality factors: tobacco and alcohol addiction.

Jill was relieved to know that she wasn’t being silly worrying about loneliness. “There was a part of me that thought maybe I was worrying about nothing,” she says. “Or that this is none of my business. But now I feel as if my worries make sense, and I’m going to take some action to start helping Melody feel better.”

loneliness eating disorder

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

Research links

Social relationships and mortality risk: A meta-analytic review, Holt-Lunstad, Julianne, Smith, Timothy R., and Layton, Bradley J, PLOS Medicine, 2010

Loneliness and Social Isolation as Risk Factors for Mortality, Julianne Holt-Lunstad, Perspectives on Psychological Science, 2015.

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The 3 types of stress and eating disorders

The 3 types of stress and eating disorders

Monique is very worried about her daughter Maya. After a few years of struggling to deal with stress, Maya is now deep into an eating disorder. Monique and her husband Leonard are dedicated to helping her recover, but they are worried that stress is a major ongoing problem. 

“I worry that unless we address her stress, she’s still going to struggle,” says Monique. “Eating disorder treatment is hard, and it seems to me like if we don’t figure out how to reduce her stress, we’re just treading water with her mental health. I just don’t know what to do about it.” 

Maya, 16, has always been a sensitive child. “When she was a toddler, she was really picky about her food and clothing,” says Monique. “So I adjusted her diet and made sure I didn’t buy her any clothes with tags. She seemed to do OK for years, but when puberty hit, she started spiraling into stress. Now it seems like she just can’t handle life, and it’s not as simple as it was when she was little and I could control everything and reduce the stressors.” 

Everything that Monique says makes sense. And she’s right: without addressing Maya’s struggles with stress, it will be hard to achieve eating disorder recovery and, ultimately, mental health. 

Why so stressed?

To get started, I asked Monique some questions about what stresses Maya out. Based on her childhood experiences, it sounds like Maya is a highly sensitive individual. This means that she is naturally more sensitive to stressors. But what exactly is creating so much stress for Maya right now?

I started by defining the three types of stress and how they appear when a person has an eating disorder. The three types of stress are:

1. Healthy stress

Not all stress is bad! We need stress to learn and grow. Without stress, we would never achieve maturity. This stress is healthy and adaptive, but that doesn’t mean it’s comfortable. In fact, healthy stress can trigger all the troubling signs of emotional dysregulation, including yelling, crying, and avoiding tasks that seem impossible. However, when a person faces their healthy stress with courage, their struggles build emotional resilience and maturity. A person cannot mature without healthy stress! 

It’s not really the type or size of the stress that you experience but your ability to cope with the stress that defines whether stress is helpful or toxic. 

Some forms of healthy stress that your child must navigate if they have an eating disorder include:

  • Eating enough food
  • Eating regularly throughout the day
  • Body changes (e.g. weight gain)
  • Going to therapy, medical, and nutrition appointments
  • Disagreeing with parents and siblings
  • Being assertive about needs and boundaries
  • Going to school
  • Completing difficult school tests and assignments 
  • Studying
  • Having reasonable expectations of extra curricular activities
  • Making new friends and socializing
  • Having social media limits
  • Getting to bed at a healthy time each night

🔑 The key if your child is experiencing healthy stress is to validate their experience (e.g. “this is hard”) while also expressing confidence in their ability to handle it (e.g. “I know you can handle this.”). Seek ways to support your child through healthy stress daily, and get coaching and support if this is a struggle for you.

2. Traumatic stress

This sort of stress is related to a specific event or action. It overwhelms a person’s coping resources and may become stuck if not processed. Common forms of traumatic stress include:

  • Serious accident 
  • Physical or sexual assault
  • Physical or emotional abuse
  • Exposure to traumatic events at home, including domestic violence
  • Serious health problems, such as heart surgery, cancer, etc.
  • Having a sibling or parent with a chronic illness (physical or mental)
  • The death of someone close, such as a parent or sibling
  • Divorce
  • Vomiting, choking, and painful gastrointestinal episodes

The interesting thing about traumatic stress is that it doesn’t impact everyone equally. Two people can face the same traumatic event, and one may develop traumatic stress symptoms while the other may not. The difference between ongoing symptoms after traumatic stress is whether the event is processed healthily. Some people can do this by themselves, but many others need a lot of emotional support to process a traumatic event. 

For example, many kids get through their parents’ divorce without any PTSD, while others need some help processing their feelings about the divorce and its impact on the family.

🔑 If your child is experiencing traumatic stress, the key is to get them professional support to process their trauma. A therapist specializing in PTSD will support your child in facing their fear and overcoming the long-term impacts of traumatic stress. You can also learn skills to respond to your child’s PTSD appropriately.

3. Chronic stress

Chronic stress builds over time. A person experiencing chronic stress often feels stuck and unable to make changes to improve their life. This sort of stress is often entrenched and hard to break out of, but parents can help. According to Yale Medicine, some symptoms of chronic stress include: 

  • Aches and pains
  • Insomnia or sleepiness
  • A change in social behavior, such as staying in often
  • Low energy
  • Unfocused or cloudy thinking
  • Change in appetite
  • Increased alcohol or drug use
  • Change in emotional responses to others
  • Emotional withdrawal

Common stressors to be aware of in your child’s life include:

  • Difficult family relationships, especially with parents and siblings
  • Lack of sleep
  • Lack of family structure and support
  • A heavy workload at school 
  • Pressure to achieve certain grades and achievements
  • Intense sports activities/expectations
  • Pressure to perform at very high levels at school or in extracurricular activities
  • Bullying
  • Overuse of social media 

Chronic stress needs to be addressed to recover from an eating disorder. Your child’s lifestyle must change to reduce chronic stress and build experiences of healthy stress. 

🔑 There are two keys if your child is experiencing chronic stress. The first is to reduce unnecessary stressors in your child’s life. This can begin by looking at their schedule and removing non-essential activities and pressure to perform. The second is to turn the necessary stressors of life (e.g. eating, going to school) into healthy stress. With the right approach, you can help your child gradually turn chronic stress about eating and other stressors into healthy stress. 

Maya’s stress and eating disorder

I reviewed Maya’s stress with Monique using a worksheet I created. Together, we identified three primary issues that need to be addressed right away: 

Eating Stress (chronic)

Maya feels tremendous stress about eating. She is worried about food all day, and it is hard for Monique to calm Maya enough to get the nutrition she needs to recover. 

🔑  This is chronic stress that can be turned into healthy stress. In combination with Maya’s eating disorder treatment team, Monique can support Maya and help her face the stress of eating with courage and determination. Over time, she will learn to face eating and mealtimes as healthy stress. While eating may continue to be challenging for her, she can transform it from chronic stress to healthy stress. 

Sibling Stress (chronic/traumatic)

Maya and her brother Victor have a negative relationship. Victor is aggressive with Maya and frequently criticizes her. Sometimes he even gets physically violent and pushes or pinches her. 

🔑  This is chronic stress that needs to be eliminated. Monique and Leonard need to immediately seek therapy for Victor and set firm boundaries around how he treats his sister. Monique and Leonard must intervene whenever they observe Victor being aggressive, critical, and violent with Maya. There should be a zero-tolerance policy for these behaviors in the household. Additionally, they should have Maya see a trauma specialist who can determine how best to address any trauma resulting from her brother’s treatment.

Performance Stress (chronic)

Maya feels overloaded with homework and tests. She has a lifelong dream of attending an Ivy League university. The pressure to perform has become overwhelming, and Maya spends hours trying to motivate herself to do homework and study. Her grades have been steadily slipping, and she often stays up until 2 a.m. trying to complete her work.

🔑  This chronic stress needs to be adjusted. While academic goals can be a healthy form of stress, it is clear that they have crossed the boundary and become chronic stress. Maya needs support from her therapist to re-evaluate her goals and get healthy study habits and boundaries in place. Monique and Leonard should meet with Maya’s school counselor to determine reasonable expectations and help Maya manage her academic goals. 

Moving forward

Understanding Maya’s stress helps Monique and Leonard see how stress affects Maya and how they can help her start having less toxic stress in her life. Knowing the three types of stress affecting eating disorder recovery has given them the confidence to start making changes at home and in Maya’s treatment program. 

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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

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Reasons why a child might be emotional eating

Reasons why a child might be emotional eating

When you think your child is “emotional eating,” it typically raises red flags. Most parents worry that emotional eating will lead to weight gain and long-term health complications. Some parents worry that emotional eating is an early sign of an eating disorder. So let’s find out what emotional eating is, why it might be happening, and what you can do to help your child. 

What is emotional eating?

Typically when parents worry their child is emotional eating, they report these signs: 

  • Weight gain
  • Eating more than the parent thinks the child should need
  • Snacking a lot
  • The child craves carbs and sugar
  • Conversations in which the child says they can’t stop thinking about food or can’t stop eating
  • Post-eating bellyaches and bloating

If these are your concerns, I understand. Parenting around food and weight is tricky. But also, please be careful! Because if you label your child as an “emotional eater” you risk pathologizing hunger and not supporting your child’s lifelong health.

Emotional eating is considered a bad thing. Parents who say their kids are emotional eaters are worried about their physical and mental health. In our culture having “too much” hunger is greedy and enjoying “too much” food is pathological.

But all eating is emotional because physiological sensations, including hunger, trigger emotions. A lack of food creates an emotional state, most often irritation, anger and a drive to eat. This is biologically adaptive and not unique to your child. All mammals are wired to respond to the physical sensation of hunger with a craving for food and emotions like aggression or anger to help them acquire it. 

Think back to when your child was an infant. Your baby’s first demand was most likely for food. I would guess your baby felt hunger and displayed an emotional response like crying and looking mad to get your attention. When a baby feels hungry, they scrunch their face in anger and cry loudly to attract their parents’ attention and meet their needs. 

Now consider your infant’s emotional response to being fed breast milk or formula. You probably noticed a look of contentment, peace, even joy on your baby’s face when being fed. Eating is inherently emotionally pleasing – it’s meant to be! All mammals have an emotional response when they are hungry an an emotional response when they are fed.

Thus, feeding kids is inherently emotional, and we should avoid pathologizing a natural instinct or suggesting a mental health condition when there is none.

How you address your child’s emotional eating can make a huge difference. Your response may help them learn self-care and intuitive eating. Or it could lead them to adopt maladaptive behaviors like binge eating and restriction. This matters, so I’m glad you’re thinking about it!

The reasons your child is emotional eating

The usual reaction when a child is emotionally eating is to assume something is wrong with the child’s mental health. But often, the solution is far simpler than psychology. It’s most often structural and, therefore, within your control. Here are the main reasons your child may use emotional eating: 

1. Hunger

Hunger is a physiological symptom that triggers an emotional reaction. Think of the term “hangry,” which perfectly demonstrates what happens when a person is hungry. They get grumpy, angry, and have trouble concentrating. They will start to crave highly palatable foods like carbs and sugars because their blood sugar is dipping dangerously low. The first question to ask if your child is using emotional eating is whether they are getting enough food on a regular basis. If you’re unsure, please talk to a non-diet dietitian who can help you figure out how much food your child needs at this stage in their development. Most parents are surprised to find that it’s far more than they thought.

2. Lack of feeding structure

Emotional or chaotic eating is often due to a lack of feeding structure. When there is an inadequate feeding structure, the child’s hunger is out of balance, and they find themselves frequently hungry and dysregulated. Parents should serve kids food every 3-4 hours. This typically includes 3 meals and 2-3 snacks. Having a feeding structure eliminates almost all feeding issues and is the primary treatment for any type of eating disorder. Unless you begin with a solid structure, your child will continue exhibiting signs of emotional eating. 

3. Poor sleep hygiene

Sleep is essential for many reasons, including appetite regulation, digestion, and emotional regulation. Before you worry that your child has any sort of mental health issue or diagnose them with emotional eating, ensure that they have good sleep hygiene. Therapy and nutritional advice will not help a sleep-deprived child. Like a feeding structure, sleep is essential to physical and mental health. 

4. Emotional dysregulation

If all of the above conditions are met but your child is still emotionally eating, your child likely needs help with emotional regulation. It’s our job as parents to help our kids develop emotional regulation by co-regulating with them and building their emotional literacy throughout their lives. We can learn this skill and teach it to our kids. So once all the above conditions are met, emotional regulation is the next area to focus on. 

What can parents do to stop a child from emotional eating?

Most of the time, the best thing a parent can do to stop a child from emotional eating is to attend to our parental responsibilities. Make sure your child is getting enough food on a consistent schedule. Ensure they get the sleep they need with a stable bedtime. And finally, work with them on emotional regulation to help them label emotions and work through emotional dysregulation. 

Once that is covered, learn how to talk about food neutrally. This means not labeling food as good or bad. Instead, talk to your child about how to balance food to feel satisfied and avoid getting too hungry. For example, a meal should ideally include fat, carbs, protein, and fruit/vegetables. A snack should ideally include at least two of those elements. This simple model can help children learn to feed themselves in a way that keeps them satisfied for several hours and will reduce chaotic eating driven by hunger and the associated emotions.

Avoid cutting out food groups unless your child has a medically diagnosed allergy. It is common to restrict foods like wheat and sugar based on non-medical diagnosis, but this can lead to disordered eating for many children. The best diets are balanced and incorporate a variety of food from all food groups. They also include highly-palatable foods like cookies and chips as part of the variety.

This is the prescription for raising healthy children who can regulate their emotions and eat healthfully. It also prevents and treats most eating disorders.

What not to do if your child is emotional eating

Most parents address emotional eating in the wrong direction. They assume the problem lies in the child. Parents believe they should tell the child to eat less or educate them about nutrition and the dangers of weight gain. This is understandable, but it’s also not the right approach. 

Most children who are treated this way will feel shame about their bodies, their hunger, and their character. This could lead to restricting food, which exacerbates emotional eating, binge eating, and a cascade of disordered eating patterns that may develop into a full-blown eating disorder. 

Restricting food and intentional weight loss are culturally normalized behaviors. However, they do not result in improved health. 95% of people who intentionally lose weight gain it back, often plus more. The No. 1 predictor of weight gain is not how much food a person eats but how many times they have intentionally lost weight (i.e., dieted and weight cycled). Additionally, teens who diet have up to 15x greater chance of developing an eating disorder.

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Frequently asked questions about emotional eating

I know this is a fraught topic. It’s very hard to parent around food and body issues in our culture, which is toxic to both. Societal beliefs about eating and weight can get between you and raising a healthy child. So here are some answers to frequently asked questions about emotional eating:

1. But what about weight gain?

Children need to gain weight to grow and should continuously gain weight throughout their childhood and adolescence. If you are feeding your child regularly and serving them enough food, and they have good sleep hygiene and emotional regulation, their weight will sort itself out according to their genetic and environmental conditions. Any attempt to intentionally manipulate weight predicts weight gain and eating disorders.

2. But my child is already eating too much food

I encourage you to consult with a non-diet dietitian who can talk to you about the quantity and variety of food your child requires to be healthy. They can help you determine what to serve your child, how often, and when. This structural support will give you the confidence that your child is eating appropriately for their unique body.

3. My kid snacks on chips and cookies all the time but doesn’t eat meals

This is most likely a structural issue. The evidence-based feeding system called Division of Responsibility, developed by Ellyn Satter, lays out exactly how parents can set boundaries around meals and snacks. This includes a feeding schedule and providing adequate eating opportunities and a variety of food in a pleasant atmosphere. If you follow the Division of Responsibility, you will likely no longer have this problem.

4. My child only wants to eat carbs and sugar

See numbers 2 & 3 above. This problem will be resolved once you have the right structure in place.

5. My child says they can’t stop thinking about food or can’t stop eating

This indicates a preoccupation with food. The most likely culprit is a lack of feeding structure and hunger. Once you have addressed the structural issues, work on emotional regulation skills and emotional literacy. Is your child physiologically hungry or hungry for emotional care? Don’t ask them – just tune in and determine whether they need more emotional care from you. Make sure they are getting enough food on a regular schedule. If you’re sure it’s not physical hunger, then fulfill the emotional need. Our children are usually hungry for attention, affection, and acceptance. So give them more of that! 

6. My child eats to the point of having a bellyache or bloating

When a child gets too hungry, they will most likely feel discomfort after eating. So the first thing to address is the feeding schedule and ensuring that your child is eating enough food regularly throughout the day. If the structural issues are addressed, and your child is still eating beyond comfortable fullness, then examine what emotional need they are trying to fill with food. Are they lonely, tired, or sad? Give them more affection, attention, and acceptance throughout the day and particularly before and during meals so they are not trying to fill an emotional void with food. Get some parent coaching and support if you’re trying to do this and it’s not working.

7. What if it’s an eating disorder?

If you are concerned or suspect that your child’s emotional eating is an eating disorder, then please reach out for a diagnosis by a trained health professional, ideally who has extensive experience with eating disorders.

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

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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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 many families facing anorexia.

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

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 many 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 many to be the first 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. The primary focus of FBT is weight gain and it is seen as a viable alternative to residential treatment for that outcome.

Who does FBT work best for?

Family-based treatment (FBT) is an effective intervention for 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. As of 2018, 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. As of 2018, 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.

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). FBT is delivered in 3 stages with decreasing levels of parental control over feeding.

The second session of treatment includes a family meal. During this meal 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, including a review of weight gain. These meetings 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 is not a fit for every family, many find it very helpful.

Stage 1 of FBT is designed to replace inpatient treatment for an eating disorder. Eating and weight gain are the priority, similar to how they form the foundation of inpatient treatment. Typically the person with the eating disorder is able to continue attending school and participating in activities as long as they are eating and gaining weight.

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

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 gain weight and 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. And, 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 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.

fbt-informed parent coaching anorexia

FBT-Informed Parent Coaching

for a Child or Teen with Anorexia

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 other treatments for anorexia, especially in cases where it’s caught early. However, if it’s not a good fit for you and your child is not gaining weight, you should know within four weeks. If that is the case, you may want 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. FBT is great when it works, but it’s not the only path to recovery. 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, and it can last up to 3 months or even longer. 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 support makes the job easier.

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 issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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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 issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.

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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: 


  • 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.


  • 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.

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 issues, body shame and eating disorders.

She’s the founder of and a Parent Coach who helps parents navigate eating disorder recovery and other challenging emotional and behavioral issues.