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The risks of accommodating an eating disorder

The risks of accommodating an eating disorder

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

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

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

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

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

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

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

What is accommodation?

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

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

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

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

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

The accommodation snowball effect

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

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

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

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

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

How does accommodating impact eating disorders?

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

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

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

Eating disorder accommodation examples

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

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

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


How can parents stop accommodating?

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

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

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

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

Start with you

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

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

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

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

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

Rachel and Lily

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

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

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

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


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

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

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

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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

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Health myths you should ignore to prevent eating disorders

Myths you should ignore to prevent eating disorders

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

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

Raising healthy kids

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

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

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

The relationship is what matters

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

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

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

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

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

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

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

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

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

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

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

Myth 2: I need to lose weight to be healthy

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

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

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

Ask yourself: 

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

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

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


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

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

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

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

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

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

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

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

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

Myth 4: health is something I can see

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

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

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

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

Moving forward

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

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

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

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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

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SMART goals parents can set in eating disorder recovery

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

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

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

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

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

What are SMART goals? 

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

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

Specific: What is the goal? 

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

Measurable: How will I measure progress?

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

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

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

Relevant: Why is this goal important? 

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

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

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

Why are SMART goals important? 

SMART goals are important because they help parents:

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

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

How can SMART goals help with eating disorder recovery?

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

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

Working on SMART goals

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

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

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

SMART goal template & examples

SMART goals for recovery example: eating

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

SMART goals for recovery example: therapy

How to make a SMART goal

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

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

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

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

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

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

Measuring success

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

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

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


Setting the clock

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

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

Celebrating success

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

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

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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

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3 brutal truths about kids’ body image

Kids’ body image report: 4 brutal facts

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

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

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

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

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

Here are three brutal truths about kids’ body image:

1. Most people have bad body image

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

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

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

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

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

2. Girls have bad body image

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

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

3. Boys also have bad body image

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

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

What parents can do to improve kids’ body image

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

1. Respect your body

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

2. Respect other people’s bodies

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

3. Respect your child’s body

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


4. Teach media literacy

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

5. Look out for signs of trouble

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Parent training for eating disorder recovery

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

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

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

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

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

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

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

How SPACE works

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

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

Is anxiety a factor?

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

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

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


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

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

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

Setting goals

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

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

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

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

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

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

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

What results can I expect?

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

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

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

Facing difficulties

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

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

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

Give it time

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

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

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

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

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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

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

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

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

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

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

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

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

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

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

SPACE treatment for eating disorders

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

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

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

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

1. See nagging for what it is 

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

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

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

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

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

2. Make what’s unseen, seen

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

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

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

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

The former is supportive. The latter is threatening.

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


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

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

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

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

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

5. Don’t just say it, show it

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

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

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

6. Practice, not perfect

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

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

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

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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How to talk about your daughter’s body

How to talk about your daughter’s body

Many parents wonder how they can talk about their daughter’s body without hurting her body image. I’ve come up with some guidelines for what to say and what not to say when you talk about your daughter’s body. I’ve also included the three things you should also be talking about that will impact your daughter’s body image and mental health. Combined, this advice will have a significant impact on how she feels about herself. 

What you can say about your daughter’s body

There are a lot of wonderful things you can say that will increase your daughter’s sense of worth and strength. But the fact is that female bodies are under tremendous pressure in our society. This means that when you talk about your daughter’s body you need to be aware of the social pressures on her body and adjust your comments accordingly. This will help her grow into a strong, resilient, and self-aware person.

Talk about what her body does

The majority of your comments about your daughter’s body should be related to what her body can do instead of what it looks like. For example, talk about how she uses her body to have fun, like turning cartwheels or running down a hill. Or you can talk about how she uses her body to get places and do things like walk to school, eat delicious food, and laugh with her friends. Her body is involved in all of those activities, and they have nothing to do with what her body looks like. When you talk about your daughter’s body you should spend most of your time focusing on her body’s incredible functionality. For example*:

  • Your legs were flying when you ran down that hill!
  • I’m really glad that you’re able to walk to school every day and that your body is able to get you where you want to go.
  • Aren’t you glad you have a tongue to taste this delicious ice cream?
  • Do your eyes see how delicious that pizza looks? I wonder if it tastes as good as it looks?

*My examples assume ability. Of course, not all bodies can do all things, and I acknowledge that.

Talk about how her body feels

It is a key skill for a woman to tune into whether she feels comfortable or uncomfortable, pleasure or discomfort. This is a skill that will keep her safe, healthy, and happy for life. You want her to be able to tune into her body’s signals and trust herself to make good choices. 

Therefore, try to avoid telling her what her body should feel and whether she is comfortable or uncomfortable. Instead, be curious about her experiences of comfort and discomfort. Here are some ways you can talk about her body’s comfort level and raise her self-awareness:

  • It looks like you feel uncomfortable in that shirt, is it itchy or scratchy?
  • Grandma’s hugs feel warm and cozy to me, how do they feel to you?
  • I’m sensing you might be cold, is that true?
  • Your body looks angry right now because your fists are clenched, is that true?
  • It seems like you’re feeling worried because you’re pacing around the room.
  • Would you like to hug Uncle Jeremy goodbye today?
  • You’re telling me your tummy is very full, which is uncomfortable. Let’s just rest here together for the next 20 minutes and see how you feel.

Talk about how she looks

There will be (hopefully many) moments when your daughter seems like she is the most beautiful thing in the world. It’s OK to think your daughter is beautiful! Beauty is something we find in nature every day. The important thing to notice is that natural beauty is never perfect. It also isn’t being marketed and sold to us. Unlike the beauty industry, which enforces harmful standards and extracts a hefty price, we don’t have to pay for nature, and it’s not selling us a solution to a manufactured problem. 

Look at your beautiful daughter as a part of nature. When you talk about your daughter’s beauty, you should feel deeply that she is 

beautiful inside and out …

with, not in spite of her flaws …

and she does not need* to do anything to make herself more beautiful.

*she may choose to do things like dress up, use makeup, etc., but those should be choices she’s making, not compulsions she’s performing to seek worthiness.

But sometimes it’s not a deep existential experience. You just want to give her a quick compliment and tell her she’s cute, adorable, or gorgeous. Maybe she looks great in that color, or her eyes are sparkling today. That’s OK, too! Just keep these compliments short and sweet. Avoid making them the main way you share your admiration of who she is.

What you should not say about your daughter’s body

Unfortunately there are some major landmines when it comes to talking about your daughter’s body. You should avoid talking about the following things:

Don’t talk about what she weighs

Body weight should be a neutral number, like height or shoe size. But of course that’s not the case. Decades of intense marketing and advertising have taught us that the higher a woman’s weight, the less attractive and worthy she is. This is appalling, but it’s the society we live in. 

Therefore, I typically advise parents to not talk about weight in any way unless they have been specifically coached in anti-diet, weight-neutral practices. This is because all of us need significant un-training in order to talk about her weight without stigma and shame.

Read more: Weight Stigma and Your Child: What Parents Need to Know

Don’t talk about how she compares

Women are taught to compare body parts, outfits, and all aspects of their appearance to other women. They are taught there is a scarcity of love and worthiness that can only be attained through “winning” at beauty standards. Your daughter deserves to grow up knowing that she is worthy exactly as she is, and that she does not need to compete against others to earn your (or anyone’s) love.

Don’t compare your daughter’s body, beauty, weight, or appearance (positive or negative), to anyone else. Show your daughter that her body’s weight and appearance have nothing to do with her value by never comparing her body to another’s body.


Don’t talk about what she’s wearing

Your daughter will wear clothes that you don’t like. Think very, very carefully about what you say about those clothes. Because her body should, first and foremost, belong to her (not you or anyone else). That means that what she puts on her body should almost always be up to her.

If you feel compelled to comment on what she’s wearing, take a breath. Think deeply about whether your comments about what she is wearing are necessary or helpful. Are they kind? Do they respect her as the sovereign ruler of her own body?

If you truly believe her clothes are “inappropriate” (look out for fatphobia and rigid gender norms here), you can make a simple statement. Say something like “I’m sorry, but I’m having a hard time with that outfit. I need to think about why it’s hard for me in order to give you a good explanation, but right now I’m not comfortable with you wearing that to school.” 

Only use this statement rarely. Trust that she will find her own path. Support her in wearing clothes that feel authentic to her unique self, not your vision of what you wish she would look like. Remember that fashion crimes are not criminal, and bodily autonomy is a basic human right.

Read more: You’re Wearing That?

The foundation of self-acceptance

The dos and don’ts of body talk are important. But it’s also important to build a foundation of body acceptance. Here are three essential steps to raising a daughter who doesn’t hate her body:

1. Watch how you talk about your body and other bodies 

Think carefully about how you talk about your own body and other people’s bodies. Our kids learn from what we do more than what we say. So if you are criticizing your own body or talking negatively about other people’s bodies, that’s a problem. 

Rigid and ridiculous beauty standards are fatphobic, sexist, and damaging to mental health. Eating disorders are skyrocketing, and anxiety and depression about weight and appearance are a major problem. Girls and women experience both at much higher rates than boys and men, making this an important thing to think about if you have a daughter.

Here are common things you might be tempted to say about your body that you should stop saying:

  • I can’t wear that (subtext: it’s not flattering/I’m too fat)
  • No way could I eat that (subtext: it will make me gain weight)
  • I can’t leave the house without makeup (subtext: my natural face is unacceptable)
  • If I eat that I would have to spend the rest of the day in the gym (subtext: eating food requires compensatory behavior)

Here are common things you may be saying about other people’s bodies that you should stop saying:

  • She looks amazing now! (subtext: because she lost weight/is thin)
  • That person just doesn’t look healthy (subtext: they are fat and fat is bad)
  • She’s let herself go (subtext: she’s gained weight and that’s bad)
  • How can she leave the house like that? (subtext: she’s not meeting societal beauty standards and she should)

Remember that even very young children (toddlers!) will pick up the subtext. It’s impossible to live in our society and not translate technically benign statements into fat-shaming and body-shaming. Your daughter is watching and listening to you all the time. For the sake of her long-term health, work on your own body image and weight stigma, and release outdated gender norms.

2. Build media literacy

Our society is cruel to bodies. Parents need to counterbalance this cruelty by teaching media literacy. These conversations need to happen early and often.

Sexism, fatphobia, and objectification are a significant part of our media landscape, and if you aren’t talking about this, your child is picking up messages about beauty and how women are valued without your consent or input. You don’t need to raise your child in a bubble, but you do need to actively counter-educate her about how the media influences what we think and believe.

At a minimum, you should talk to your daughter often about these concepts: 

  • Almost all advertisements, TV shows, movies, and social media posts involve heavy editing and filters. Even if they don’t use filters, the person has likely spent hours perfecting their hair, makeup, and outfit, getting the right pose, and setting up professional lighting, etc. What you see on the screen almost never represents what a person looks like in real life.
  • Bodies, particularly women’s bodies are often used as sales tools. For example, an apartment building may use a photo of a woman in a bikini to advertise their apartments. This advertisement may appear next to another one featuring a man who is wearing a suit and tie. We need to ask questions about this. For example: why is the man wearing clothing but the woman is wearing almost none? Also notice that many times women’s bodies appear without their heads or even as individual body parts in order to sell products. This depersonalizes the female body and treats it as an object and a sales tool.
  • Just because someone on social media or TV says something is true does not mean it is true. Many times the person is speaking from personal experience, but that experience cannot be extended to you. Additionally, a lot of times the person is being paid or is hoping to be compensated when they promote products or services.
  • If something on social media or TV sounds too good to be true or promises a quick, easy fix, then it’s probably not true. Most things in life are full of nuance and complexity.
  • Pay attention to diversity – or lack thereof. If everyone you see in the media is white, thin, heterosexual and cisgender, then adjust your media consumption, or at least talk about the problem.
  • Advertisements are successful when they create a problem that the product can solve. Therefore, media messages about “problems” are made up by advertising agencies. For example, wrinkles, weight, cellulite, and skin color are largely genetically predetermined. We have very little control over these features. The products designed to “solve” the so-called problems are neither necessary nor do they work as promised.

3. Talk about her other qualities 

Spend the bulk of your time talking about your daughter’s non-body qualities. This is really important, because the problem is not talking about your daughter’s body, but rather talking about her body at the exclusion of her other qualities. Her body is a part of her, but she should not believe that her value and worth are based on her appearance.

In general, you should spend the majority of your time focusing on her non-body-based qualities. Body and appearance comments should be the small minority of what you talk to your daughter about.

Instead of focusing on your daughter’s body, talk about her:

  • Creativity
  • Sense of humor
  • Kindness
  • Thoughtfulness
  • Attention to detail
  • Mental flexibility
  • Courage
  • Friendliness
  • Trustworthiness
  • Dependability
  • Grit
  • Passion
  • Purpose
  • Curiosity
  • Dedication
  • Adventurousness
  • Daring
  • Warmth
  • Loyalty
  • Open-mindedness

When you talk about these qualities, praise her for her behaviors, not the outcomes. This has been demonstrated in the research around the “Growth Mindset,” which is that focusing on outcomes can raise a perfectionistic, rigid mentality. Outcome-based praise can also be de-motivating and spoil the joy of trying new things. Here are a few examples:

It’s really great that you put so much effort into your school project.I’m proud of you for getting good grades.
I love that you’re putting so much creativity into your role in the play.You’re the star of the show!
You were very brave to try out for the softball team.You making the softball team is very important to me.

As with appearance, of course you can sometimes mention outcomes, but be sure that the majority of your praise is about the behaviors you admire. 

Finally, if your daughter is calling herself names or being cruel to her body, here’s an article to help: What to do when your tween says they’re “fat” and other tricky situations.

Navigating body image is difficult, but following these steps should help you raise a strong, confident person!

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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When your child gets violent during eating disorder recovery

When your child uses violence during eating disorder recovery

Sometimes when a child has an eating disorder they may get aggressive and even violent with family members. This is a deeply upsetting situation for parents. It’s especially hard when parents are already worn out from months or even years of caring for a child who has an eating disorder.

The first thing to know is that getting angry, aggressive, and even physically violent are known symptoms that can accompany an eating disorder. They have been studied and observed in anorexia and bulimia. The most common symptoms are verbal and physical aggression against relatives and others who are close.

The most likely reason for the aggression is that it is a natural response to fear and anxiety. The two most common responses to fear are fight and flight. Fight typically looks like aggression and violence. It is often a signal that a person is experiencing extreme fear and anxiety.

Getting violent during eating disorder recovery can make sense through this lens. Anxiety often underlies and drives maladaptive coping behaviors. It makes sense, and it needs to stop. 

emotional regulation

What it feels like

When a child gets physically violent during eating disorder recovery, parents can feel shocked, overwhelmed, and afraid. There’s so much shame and stigma around kids hurting their parents, and it’s rarely spoken about. 

Violent behavior can happen during eating disorder recovery, but it’s also not acceptable. And there are no conditions under which a parent should accept violence. Additionally, your child’s violence is a symptom of extreme emotional distress. This means that ignoring it or pretending it’s not happening is dangerous for both your child and you.

Often it feels like the only possible responses to violence are to fight back, endure/ignore the violence, or call the police. Fighting back rarely ends well for anyone. And it can add to the shame involved for both parent and the child. And enduring or ignoring violence is unacceptable and, like fighting back, is dangerous for both the child and the parent.

The other response, calling the police, is something you may need to do at some point in the future. But most parents want to avoid that. And there are some steps between doing what you’re doing right now and calling the police.

How to prevent and handle violence

Here are some steps you can take to help prevent and respond to violent behavior during eating disorder recovery and keep yourself and your child safe:

1. How you respond

The most common response to violent outbursts is to fight back with some form of physical or verbal wrestling. However, this rarely defuses the emotional tension that drives a person to a violent outburst. Fighting back is ineffective and often makes the outburst worse.

Violent outbursts are usually the result of extreme emotional disruption. And while it may feel as if it comes out of nowhere, there are usually patterns and signs that a violent outburst is coming. 

Before a violent outburst, your child will show symptoms of emotional dysregulation. These may include shifty eyes, tense body posture, pacing, or loud voice. Some kids will signal their dysregulation by swearing or name-calling.

Parents should be aware of the signs of patterns that signal a violent outburst is building and take steps to try and soothe their child’s nervous system as soon as possible. Here are some ways to avoid and/or get through aggressive and violent behavior when your child has an eating disorder:

Manage your own emotional dysregulation

Possibly the hardest thing to do when your child is getting aggressive and violent is to maintain your own emotional regulation. But if you are not emotionally regulated then your child will have a very hard time becoming regulated in your presence.

Work with a professional coach, therapist, or guide who can help you identify your common forms of emotional dysregulation and learn to regulate yourself with self-compassion and mindfulness.

If at any point during an aggressive confrontation you notice yourself becoming dysregulated, try to calm yourself. But if you can’t, take a break. Don’t blame your child for this by saying something like “You’re out of control so I’m leaving!” Instead, tell your child “I’m very upset right now so I’m going to take a break.” Then leave. Give yourself at least 20 minutes, which is how long it typically takes to soothe your nervous system.

Always come back to your child and talk about what happened. Leaving is not a problem, but if you leave without talking about it later, that will put your relationship at risk.

Label and mirror their feelings

An essential emotional regulation skill is to label and mirror your child’s feelings. This is a way of soothing your child. This is because it shows that you are attuned to them and accept their feelings as valid and real. This step alone can transform your relationship with your child. This may not work if your child is already at the point of violence. But it can be used very effectively in the moments leading up to violence and may even prevent it.

Labeling is when you name your child’s feelings. You could say something like “I can see how angry you feel right now. You’re pacing and look agitated.” This video about the concept “name it to tame it” might be helpful:

Mirroring is when you repeat about three of your child’s words back to them. For example, if your child says “you never listen to me and you’re always telling me what to do!” You could mirror back something like “it feels like I don’t listen to you.” If your child says “you can’t make me do it if I don’t want to!” You could mirror back “you don’t want to.”

When mirroring your tone of voice matters just as much, and maybe more, than the words you say. Use what Chris Voss in his book Never Split the Difference: Negotiating As If Your Life Depended On It calls the “late-night DJ voice.” Imitate the voice of a late-night DJ: slow, steady, and soothing. With this voice, you comfort both your child’s and your own nervous system. It taps into your shared neurobiology to soothe and reassure. It communicates: we can handle this.


If your child does not calm down and moves aggressively towards you, calmly narrate what is happening in a supportive and non-judgmental manner. You could say things like:

  • I sense how furious you feel, but it’s not OK to push me. I’m confident we can get through this without pushing.
  • I can see that you are very angry, but I will not allow you to hit me, so I’m going to leave now. I’ll come back in about 20 minutes and we can try again.
  • I understand that this is making you feel very upset, and you get to feel that way, but I’m not OK with you threatening me. Let’s sit here together and I know we can get through it.

These statements do the same thing:

  • Label the child’s feelings and name the inappropriate behavior
  • Set a clear boundary
  • Show confidence that you can handle it

Your child may not like it when you do this, but that doesn’t mean you’re doing it wrong.

Keep your narration short, simple, and factual. Don’t editorialize or debate what you’re saying with your child. Use the “late-night DJ voice” and keep your voice calm and regulated.

Don’t debate

One key in responding to anger is to not engage in debates with it. You will never win a debate when a person is in extreme emotional dysregulation. Most parents believe there must be a perfect verbal response to violence that will stop it. They think that other parents have figured it out and are doing better than them. But that’s simply not the case. 

Eli Lebowitz, author of Treating Childhood and Adolescent Anxiety suggests you focus not on debating but on simply getting through or getting out of the moment.

“Parents are not expected to be able to manage the disruptive situation, and instead focus on getting through it. Their only role while the child is acting in the disruptive manner is to ensure physical safety and resist being drawn into the interaction.”  – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

The passage continues with this advice: “remain silent, or state in a quiet way that the behavior is unacceptable. If necessary, parents should attempt to distance themselves from the child in order to minimize the potential for escalation.”

Follow up

Once everyone has calmed down, talk about what happened. Begin by telling your child that you know they are a good kid who was having a hard time. Tell them you are going to work with them on this because even though you know how angry they get, you know that they can handle their anger without getting violent.

Violence must be named clearly and in a detailed but non-emotional manner. Avoid pointing fingers, blaming, or criticizing. Think of yourself as a dispassionate reporter. State what you observed during the violent episode. 

Don’t ask questions like “What were you thinking?” or say things like “How dare you!” Because these will shut the conversation down or escalate another outburst. They will not be useful in preventing future violence. Maintain your own emotional regulation.

Talk through what you did in response to their outburst, and why. For example, if you narrated what was going on, tell them you did that because it’s important to name feelings and behaviors. If you left the room, tell them you needed to do that because violence is not acceptable.

If you did something that you regret, like wrestle with them verbally or physically, take responsibility for that and apologize for it without defending yourself. “When you approached me with your fist raised, I pushed you away. I’m sorry for doing that, as I have no intention of wrestling with you.” Or “When you called me that name, I cursed at you. I’m sorry for doing that, as I have no intention of swearing at you.”

You will likely need to follow all of these steps consistently a few times before you see a change in behavior.  

2. Write a letter

A written letter is a way to make clear your beliefs and what you intend to do in response to violence. It is a way to formally escalate your attempt to solve this problem and make it clear to your child that you take it seriously.

The letter I’m describing here and the next section about calling in supporters is largely based on a treatment called SPACE developed and scientifically tested by Eli Lebowitz and his colleagues. The process is much more extensive than what I’ve written in this article. If this sounds like something that may help you, please consider reading his books, Breaking Free of Childhood Anxiety and Treating Childhood and Adolescent Anxiety.

I have a treatment program for parents that teaches SPACE.

Lebowitz suggests printing this letter and giving it to your child, then reading it aloud. He also says that even if your child’s response is to put their fingers in their ears and rip the letter into pieces, it has still sent a meaningful signal to your child that you are serious about ending the violence. 

The goals of the letter are to clearly define the specific problem of physical violence and say exactly what will happen in response. This makes clear exactly what is happening and escalates the situation in your child’s mind.

One of the biggest problems with physical violence and intimidation is that families don’t talk about it. This letter states clearly what the behavior is and how the parents are going to respond from now on. 

There is a very important thing that the letter does not do. It does not tell the child what they need to do differently. This is strategic and by design. Lebowitz says that the parents need to take responsibility for what the parent will do and how they will respond, but they should not tell the child what they should do, as this will be perceived as criticism and blaming, no matter how carefully done.

Here is a sample letter: 

August, we love you very much and know how hard you have been working over the past year. We know you have been struggling to control your anger, and we’ve also noticed that lately, you have become violent with Mom. For example, on Friday when she asked you to take out the trash you called her names, cursed, pushed her, and scratched her face with your fingernails.

This has been really scary for all of us, and we know it’s a sign that you’re really struggling. We also know that you are a strong person and that you can manage your anger even when it feels so big and out of control.

We’ve been trying to ignore that this is happening and not talking about it with you, but we realize that by doing this, we’ve not actually been helping you to manage your anger. Now that we understand this, we’ve decided to make a change so that we can help you better.

We want you to know that we recognize that your behavior is because of how you’re feeling. It’s not a sign of a flaw in your character or personality. We believe in you, and we know that if we work on this together it will get better.

From now on, when your anger gets to the level of physical violence and intimidation (such as getting too close, waving your arms around, hitting, slapping, scratching, biting, or pinching), Mom is not going to argue with you, talk you down, or try to hold your arms at your sides. Instead, she’s going to tell you what she sees and what she’s going to do. Then she will walk into our bedroom and lock the door until she feels it is safe to come out.

We know that this will be hard for you, but we also know that you can handle it.

If this happens, the three of us will talk about exactly what violent behaviors Mom observed in detail. It is important to us that we specifically discuss violence and don’t keep any secrets about it even when we know that you are not intending to hurt your mom. 

We know you have been working really hard on your mental health, and we believe this is an important way that we can help you get better.

Love, Mom and Dad

3. Bring in supporters

If your child continues to physically threaten and attack you, then it’s time to enlist help from your community. This may feel like an extreme response, but it’s much less extreme and often more effective than calling the police. 

This is based on the strength of our social and community relationships. We are social beings, and the thought of someone outside the family witnessing the child’s violence can help end unacceptable patterns of violence. When done with support and love, bringing in supporters can make a huge difference.

“The role of supporters is not to shame children or embarrass them but rather to rally round the children, giving them the message ‘We all care about you, believe in you, and are going to help you.’” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

Make a list of people in your family and community who might be able to help you. You are looking for people who have high levels of compassion and a good relationship with your child. Possible options include grandparents, uncles, aunts, friends and family, sports coaches, teachers, school psychologists, guidance counselors, your child’s eating disorder treatment team, and others. 

Lebowitz suggests a list of 5-10 supporters, at least some of whom are in your physical community. Then reach out to them and explain the reason for your request.


Your request:

August has been really struggling with anger, and sometimes he gets violent with me. We are working really hard on this, and we’re reaching out to see if you’d be willing to lend a hand sometimes. We’ve been told that violence thrives in secret, but that bringing in supportive others from our community can help end it. I guess this is what they mean when they say “it takes a village!”

The first thing I’m asking you to do is call, text, or talk to August and tell him that he is important to you, that you care about him, and you understand he is working hard. However, you are aware that he is sometimes getting violent with me. Say you feel strongly that violence is a problem, and you support us (his parents) in this issue. If you’d like, you may offer to help such as being available by text or phone to support him.

Next, I’d like to tell you each time there is an incidence of physical violence. This will be embarrassing for all of us, but it’s important that we stay honest about what is going on. If this happens, I would like you to contact August and tell him you are aware of the violence. As before, please begin by telling him you care about him and believe in him. However, you are aware of what happened and that his behavior is unacceptable. If you’d like, you may offer to help such as being available by text or phone to support him.

Finally, I’ll also let you know when things are going well. This part will be much more fun, as you could reach out to August and let him know you’re proud of him. If you’d like, you could offer to do something fun with him to celebrate.

Telling your child about supporters

Once you have contacted your supporters, tell your child what you have done. You can say something like “August, your violent behavior has been escalating, so we have decided to get some community support. We have contacted [list the names] and told them about what’s going on. They’re going to contact you in the next few days, and we will also tell them each time you get violent with us.”

Your child will not like that you have told outsiders about their violent behavior. Be unwavering in your belief that this is the best approach, as your next option is calling the police, which is really a last resort. Don’t debate why you did this, who you chose, or whether it’s a terrible idea. Stay firm in your conviction that this is the right thing to do.

“Any objection on the part of the child to this step should be met with a simple statement: ‘When you act in a violent way, we will not keep that a secret.’ Parents should adamantly avoid any further discussion of this point.” – Eli Lebowitz & Haim Ober, Treating Childhood and Adolescent Anxiety

When things get violent during eating disorder recovery

This article is designed to give you ideas about how to handle violent and aggressive behavior during eating disorder recovery. As I mentioned, there are two excellent books that describe these concepts in much greater detail: Breaking Free of Childhood Anxiety and Treating Childhood and Adolescent Anxiety.

If your child is getting violent while they are in recovery from an eating disorder, then I encourage you to seek professional support for yourself as you navigate this difficult situation. You will likely need it, and you definitely deserve support. You will also be more effective if you have someone who can help you weather this storm.

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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When your child is dropped by their eating disorder dietitian

When your child is dropped by their eating disorder dietitian

Sometimes a person who has an eating disorder is dropped or discharged from the care of a Registered Dietitian (RD). Parents may wonder why this happens and whether such behavior is ethical given how fragile their child is.

It’s undoubtedly hard for parents to hear their child has been discharged. If your child is under 18, you may be the one who the dietitian informs that they are terminating treatment. In this case, you will likely get the reasoning directly from them. But if your child is over 18, there’s a good chance that you will get the news second-hand. Your child will tell you their version of why they’ve been dropped or discharged by their eating disorder dietitian.

In either case, the news can be shocking, bewildering, and painful.

Grace’s story

That’s what happened to Grace*, a client of mine whose daughter Casey* is 19 years old and has bulimia. “We’ve had a terrible week because on Monday Casey’s dietitian dropped her,” she said, shaking her head in dismay. “Why would a person do that? Casey is getting worse – she’s in terrible danger. So why would her dietitian, who has been working with her for over a year, drop her right now?”

Grace was in tremendous pain. Casey had spent the week raging against her dietitian and her whole care team. Casey’s eating disorder symptoms, which were already getting worse, ramped up to levels Grace hadn’t seen before. Her daughter was medically in danger, but because she is over 18, Grace had limited options. 

Things had been getting worse for Casey for a while. But knowing she was seeing a dietitian in person every week helped Grace feel a bit more secure. “I admit that those weekly sessions gave me hope,” she said. “At least I knew that Casey was being monitored and talking to someone who could help her.” 

“I don’t know what we’re going to do now,” she said. “I’m really at the end of my rope. And I’m so angry with the dietitian for putting us in this situation.” 

I completely understand Grace’s feelings. As we talked, we tried to understand what being dropped by the dietitian during eating disorder recovery meant for them.

Trying to find out what’s going on

I had a pretty good idea that what was going on is that Grace’s daughter’s dietitian had hit a point in treatment at which it felt medically and ethically unsafe to continue treating Grace in outpatient treatment. 

There had been months of weekly dietitian meetings and continued signs of medical instability. It sounded as if the dietitian had hit the point at which her training and expertise were at their limit. But it’s never simple, so I reached out to Leslie Schilling, MA, RDN, CEDS-S. Schilling runs a private nutrition therapy and wellness coaching business. She is also a supervisor for other dietitians working with eating disorders. 

“Ending treatment with a client is such a nuanced situation,” says Schilling. “I work really hard to avoid discharging a person from my care. Because I know how difficult it is, and it may feel like abandonment.”

“That said, there are times, particularly in a situation in which the person clearly needs a higher level of care, that I may have them sign a form or agreement acknowledging that I have recommended a higher level of care and they are choosing to continue working at this level of care instead,” she says.

“Many people don’t realize that dietitians provide a service called medical nutrition therapy. This includes some medical components like reviewing lab values, food-drug interactions, and systems assessments,” says Schilling. “And, if we see someone who is extremely medically compromised and needs to be in inpatient care, we could be at risk if we continue to treat them.”

emotional regulation

Why does it happen?

There can be many reasons a person may be dropped by their eating disorder dietitian. Here are the most common reasons: 

1. Lack of specialty

Sometimes a dietitian will start working with someone without realizing how serious their eating disorder is. Maybe when they started the eating disorder was not recognized or disclosed. But then the RD realizes the person has an eating disorder. If the RD is not an eating disorder specialist, then they would probably refer the client to someone who is qualified to treat them. 

2. No team

If a dietitian is working with someone who has an eating disorder alone, they may decide that they cannot continue without the addition of a team. This is typically a medical doctor, therapist, and possibly a psychiatrist. If a client refuses to work with a team, the dietitian may need to make some difficult decisions about the ethics of continuing care alone.

“In most cases when supporting someone with an eating disorder, I do not recommend that a dietitian work alone – you really need a complete care team,” says Schilling. “I am not a therapist, and I can’t work on certain aspects of the eating disorder the way a therapist can. I also can’t admit someone to a hospital with a low glucose level, although I can read that in their lab work. Working without a team is not a good idea when we’re dealing with an active eating disorder.”

3. Personal reasons

Sometimes a professional will begin working with someone and then need to disengage for personal reasons. This could be for family reasons like pregnancy or elder care, moving to a new practice or out of state, retiring, or a number of other situations. 

In these cases, the dietitian rarely leaves their client hanging and will typically give their client plenty of notice and provide them with referrals to other professionals. Sometimes emergencies or illnesses mean a dietitian must end treatment abruptly. While not ideal, these situations are sometimes unavoidable. This is one of the reasons why eating disorder dietitians prefer to work with a team.

4. Ethical issues

There are cases in which a dietitian must make an ethical determination about care. “At a certain point, a dietitian may need to evaluate whether their client needs a higher level of care, particularly if they are medically compromised,” says Schilling.

“Sometimes there are other things that take priority over seeing the dietitian, like acute mental health concerns or stabilizing someone medically. I’ve often stepped back while other members offer more support until the client becomes stable enough to resume nutrition therapy,” she says. 

Schilling says this situation usually begins with the dietitian exploring the issue with the patient’s treatment team, and then talking to the client about recommending a higher level of care. “If the client really wants to keep working with me, or doesn’t feel safe entering a higher level of care, then I’ll use a form or waiver that clearly states my recommendation and the client’s preference to continue working together despite my recommendation,” she says. 

She says this is important since dietitians provide medical nutrition therapy and may be at risk of liability. “If we recommend a higher level of care and the client refuses to sign the waiver, then we will still give options and referrals. This is a tricky situation that would need to be discussed with the dietitian’s professional supervisor if they have one and the patient’s treatment before discharging from care. This isn’t a decision a dietitian would make hastily.”

Thinking it through

Schilling, who supervises eating disorder dietitians in addition to treating eating disorder clients in her practice, says that it’s rare that a client would be let go without extensive conversations, attempts to make progress, and referrals to other professionals or a higher level of care.

When Grace started to think about it, we were able to deduce that this is likely what happened with her daughter Casey. Casey’s entire team has been recommending a higher level of care for months, in fact almost since they started working together. Casey’s dietitian introduced a treatment contract over six months ago, which is a way that a dietitian tries to establish treatment milestones and move a client forward in their recovery.

Grace told me that Casey complained bitterly about the contract. And while we don’t know if Casey was offered a waiver to continue care under the dietitian, it’s very likely that the dietitian hit an ethical issue in treating Casey.

Grace says Casey complains that her team is pressuring her into a higher level of care, and Grace herself has been desperately trying to get Casey to enter inpatient treatment.

In fact, that’s a big part of the work we’re doing together. I’ve been coaching Grace to build influence in their relationship and have more effective conversations about Casey’s eating disorder and treatment.

Next steps

With a bit of clarity, Grace understands the dietitian’s choice. “I still hate it,” Grace says. “It puts me in a really bad place.” 

Grace is going to have some tough conversations with Casey. Based on our understanding of why the RD released Casey from her care, we can guess that Casey is severely medically compromised. 

Grace needs to get really clear with Casey about how treatment needs to proceed. There is no easy solution here because of Casey’s age. But Grace is not willing to give up. “I’m fighting for my daughter’s life right now,” she says courageously. “I’m going to figure out how to get her the help she needs.”

*Names have been changed to protect privacy

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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Affirmations for eating with an eating disorder

Affirmations for eating with an eating disorder

Eating can be really hard when you have an eating disorder, but affirmations can help. Eating disorders are mental illnesses, which means that we need to change our thoughts and beliefs in order to recover. This is where affirmations come in. Affirmations can help us replace our disordered thoughts with healthy thoughts. Over time, this can change the pattern of our thinking and support recovery.

Common thoughts and beliefs that drive eating disorders are:

  • If I eat too much I’ll feel sick and/or gain weight
  • I can’t eat food/carbs/sugar etc.
  • Exercise is required to “burn off” food calories
  • There are some foods that are good and some that are bad
  • I can’t trust my body to make healthy choices for me
  • I’m not hungry
  • That’s too much food for me right now

These thoughts all make sense because we live in diet culture, which perpetuates them all the time. But we can overcome these false beliefs and thoughts with affirmations that counteract the eating disorder thoughts and lead us towards health and recovery.

Having an eating disorder can make it really hard to eat regularly and trust your body to be healthy. Recovery doesn’t happen with affirmations alone, but parents can support recovery by teaching their kids eating disorder recovery affirmations. Here are nine affirmations you can teach your child who has an eating disorder:

1. My body needs food every day no matter what I do

My body needs food. And it’s not just that I need food when I exercise. I need food even if all I do all day is sit on the couch. My brain, lungs, heart, and every organ in my body need food every single day just to exist. My body needs me to eat food every day. Food is the best, most essential, and healthy thing my body needs.

2. All foods are good foods

Even though there is a lot of misleading information about food out there, I know that all foods are good foods. Unless it’s moldy or expired, all food is clean. It’s not better to eat a salad instead of a burger if what I really want is a burger. What I eat should be based on what my body wants and needs, not what someone else has told me is “healthy” or “good.” Right now I need to trust my dietitian and my parents to help me make the right choices for my body. Over time, I’ll learn to listen to my body, which will guide me to eat exactly what I need every day. 

3. I can be afraid to eat and choose to eat anyway

Eating is scary for me right now. It makes sense – I mean, I have an eating disorder! But just because I’m afraid to eat doesn’t mean that I won’t eat. From now on I’m going to feel my fear and eat anyway. Trying to get rid of my fear will never work, but showing my fear that I can eat even when I’m afraid of it will help me feel stronger every day. Fear gets to exist in my mind, but I will not allow it to drive my decisions or put my health at risk.

4. I never need to burn off my food with exercise

My mind thinks that every time I eat, I need to work it off with exercise. And that thought keeps coming up for me, but I know it’s not true. Exercise is healthy as long as it’s not being used as a punishment or way to purge what I’ve eaten. Right now I need to take a break from exercising while I recover, but that doesn’t mean I need to eat less because I’m not exercising. I can’t wait until I’m exercising before I eat more food. That’s just not how bodies work. Exercise is not the price we pay for eating.

5. My body is perfectly capable of digesting food

A lot of times I feel as if I won’t be able to handle the food I eat. I worry that I’ll gain weight, that I’ll vomit, that I’ll feel nauseous, and that I’ve eaten the wrong thing or too much. All of these worries show up in my head, but that’s OK. I’m still going to eat with the knowledge that my body can digest so many things. Sure, if my doctor has diagnosed an allergy I won’t eat those things, but otherwise, I’m going to follow my dietitian’s and parents’ advice about what to eat and how much.

6. I can’t really trust my hunger and fullness cues right now, but I will if I keep eating

Right now my hunger and fullness cues are all over the place. With my eating disorder, I put my mind in charge of my body, and it’s kind of messed with my body’s natural signals. But that’s OK. I know that if I keep practicing and eating what my dietitian and parents tell me is good for me then I will slowly rebuild my brain-body connection. Over time, I’ll relearn how to listen to my body and will be able to eat intuitively, without fear, and according to my appetite.

7. My body does not need to be oppressed to be good enough

For whatever reason, I decided that my mind needs to take control of what my body needed. I’ve been treating my body’s signals like they’re naughty children who need to be dominated and controlled. But I don’t want to do that anymore. I’ve become a dictator, an oppressor! I want to treat my body with the respect and dignity it deserves. My body is strong and wants me to be healthy. My body doesn’t need to be a certain weight or shape to be good enough. It’s already good enough. Over time I will learn to listen to my body, but right now I’m going to stop oppressing it with food rules.

8. Counting calories may feel safe to me right now, but it’s not a healthy way to live

I’ve become a master of calorie counting. It happens automatically for me every time I eat or think about food. But this catalog of calorie counts is not making me healthier. It’s part of my eating disorder. Every time I start to count calories I’m going to ask my brain to stop doing that. I mean, I understand that my brain thinks counting calories will keep me safe, but I’m not buying it anymore.

9. Just because I don’t want to eat doesn’t mean I shouldn’t eat

Right now it makes sense that I don’t want to eat most of the time – I have an eating disorder! And eating has become a huge hassle and drama in my life. But I know that if I eat what and when I’m supposed to, I’ll recover from this eating disorder and won’t need to force myself anymore. So I’m going to keep remembering that even though I don’t want to eat most of the time, I’m going to do it anyway. My body really needs food, and I’m tired of my eating disorder hurting my health and controlling my life.

These affirmations should help your child gain confidence in eating disorder recovery. Recovery takes time, but repeating these affirmations supports the process of building new beliefs and thoughts. 

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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What to do when your tween says they’re “fat” and other tricky situations

What to do when your tween says they’re “fat” and other tricky situations

It’s not uncommon for a tween to say they’re “fat” or otherwise struggle with their body image.

This is an understandable but devastating side effect of living in our culture. One study found that nearly half of girls aged 3-6 years old are afraid of being fat. It only gets worse as they get older unless parents actively intervene.

Our society is deeply fatphobic. Our kids are not immune.

Parents need to help kids, particularly those who are larger, live in their bodies safely and without shame. Here are my eight tips for parents facing tricky body image situations. 

This advice helps when treating eating disorders, preventing eating disorders, and preventing a broad array of mental health issues.

1. Don’t tell them it’s just baby fat/they’re not fat, etc.

When your tween says they’re “fat,” your first response may be to try and convince them they are not. But that’s not the best approach.

Don’t say that they will grow out of it. And don’t insist that they are not fat, they are beautiful.

These statements can make a child feel even more ashamed of their body. And it also opens the door for your child to perpetuate anti-fat bias in the world.

Teach them to be a good friend to themselves and a good citizen at the same time by acknowledging anti-fat bias and teaching them how to talk about bodies with dignity and respect. 

Don’t say anything that suggests that fat is bad and something to get over and/or be ashamed of. 

Instead, talk about what it means to live in a larger body in our society. Help them understand that we are more than bodies. Give them the tools to live in the body they have.

Read more: How to protect your daughter from diet culture and fatphobia

2. Find out the feelings behind the word “fat”

Fat can be a neutral descriptor, but it can also be a way to be cruel to ourselves.

Teach kids that it’s not OK for them to be rude to themselves or use the word “fat” as a stand-in for negative feelings. 

Often when kids call themselves “fat” in a negative way, it means they are struggling with negative feelings. Ask questions.

Find out what “fat” means to them. Help them find the feeling words that fit.

In our society a tween who calls themself “fat” often means they feel sad, lonely, or rejected. 

Seek to understand and validate the feelings without trying to convince your child that they are already thin enough. The more we deny their experience, the deeper it will dig into their psyche. 

Read more: What to do when your tween daughter calls herself fat

3. Teach them about weight stigma and fatphobia

Bodies are a social justice issue. Body politics are filled with racism, sexism, and sizeism. Parents need to recognize that weight discrimination is harmful just like other forms of discrimination. Parents need to become social justice warriors who are willing to fight back against our culture of body hate.

We can build a kinder world for our children (and everyone), but it’s not going to happen without effort. 

Teaching kids about weight stigma and fatphobia is protective and will help you raise a kinder human. Bodies are beautiful, unique, and healthiest when treated with dignity.

We need our kids to recognize that trying to control bodies or judging people for their bodies is harmful and unacceptable.

All bodies deserve dignity. Help your child know this deep in their bones.

Read more: Weight stigma and your child

4. Work on your own food and body issues

Your own body and food issues will trickle down to your child. Our kids are finely attuned to how we feel, so we have to work on ourselves to help them grow up strong and healthy.

I’m not blaming you here. We have all grown up in a toxic culture that treats bodies as objects to be controlled and criticized. But when you have a child, it’s time to dig deeper and uncover your own food and body issues.

If you are dieting or otherwise controlling your weight, it’s time to stop. I know this is revolutionary, but we need to heal ourselves so we can help our kids thrive.

Please get support if you don’t know how to live without your bathroom scale and food plans. A therapist, dietitian, or coach can help you learn to practice Intuitive Eating and find peace with your body.

Read more: Get off the diet cycle and raise healthier kids


5. Teach them to accept their bodies (and never diet)

Trying to change our body size and shape doesn’t work, and dieting increases the risk of an eating disorder by up to 15x. 

To prevent eating disorders and other serious mental health issues, I encourage parents to commit to the goal of helping kids never, ever, diet. 

This means we need to help them accept their weight, whatever it is. This is counter-culture, so we need to constantly remind our kids that body acceptance is the best path to health.

You may feel proud of a child who says they want to “eat healthier,” but this is the modern-day code for dieting. Instead, teach your child to listen to and trust their body instead of following external rules and goals. 

Of course, you can stock and serve fruits, vegetables, grains, and proteins. But serve them alongside carbs, fats, cookies, chips, and other great foods. 

All foods fit in a healthy lifestyle. And the more you support a nuanced, gentle approach to bodies, the healthier your child will be.

Read more: The science to support a non-diet, weight-neutral approach

6. Help them manage peer teasing (and bullying)

It sucks, but kids are cruel to other kids’ bodies. If you have a child who is larger, they will likely experience discrimination and teasing. But even smaller kids may experience cruel body-based taunting and jeers. 

It’s not fair, but don’t make it worse by ignoring it or pretending it doesn’t happen.

Teach your child to be confident and assertive about their body. Give your child some possible responses to fatphobic jokes, and support them in standing up for themselves and others. 

This is not unlike anti-racism work, where it’s very important to prepare kids to not be passive bystanders when they witness body-based teasing and bullying. All kids should be given the tools to be “upstanders” when it comes to body-based teasing and bullying.

Make it easy for your child to report body-based teasing and bullying to you. And be prepared to speak with your school’s administration when it inevitably happens. This is an under-reported aspect of bullying, so don’t hesitate to say something!

Read more: Help your child deal with body shaming

7. Teach them to respond to adults who say “watch your weight” and “eat healthy”

Kids know that “watch your weight” and “eat healthy” is code for “your body and appetite are unacceptable.” Teach them that these comments are common, but they may hurt your child’s feelings, and you understand why.

Empower your child to politely but assertively respond to these adults. A simple “I’m good, thanks,” can work well. They can also say “please don’t talk about my body/weight/food.” 

Some adults may become offended, but that’s just because they haven’t thought about how harmful their comments about weight and food can be. There’s nothing inappropriate about your child setting boundaries about what adults say to them about their body and food.

Read more: Don’t talk about my child’s weight

Read more: Opt-out of school weight programs

8. Work harder to find age-appropriate, comfortable clothing

If you have a child in a larger body, you’ll need to work a little harder to help them have fun with fashion. Larger kids need a little extra effort and attention because the clothing industry does not recognize size diversity. 

Do your research and make sure that stores carry their size before you take them shopping. 

Remind them that the problem is never their body, it’s the sizeist fashion industry. And when things don’t fit, teach them to blame the clothes, not their body. 

Read more: How to shop for clothes when your daughter wears plus size

It’s sadly normal

It’s sadly normal for kids to feel bad about their bodies in our culture. It’s not uncommon for a tween to say they’re “fat” or otherwise struggle with their body image.

The best thing parents can do is be prepared and proactive rather than reactive when it comes to body image issues.

And if your tween does say they’re “fat” or are otherwise distressed about their body, respond with compassion and understanding rather than trying to dismiss their feelings.

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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Talking to your child with an eating disorder without yelling & screaming

Talking to your child with an eating disorder without yelling & screaming

Many parents who have kids with an eating disorder tiptoe around difficult conversations because so many of them turn into screaming or yelling matches. 

Parents who are facing an eating disorder naturally want to create a healing environment and try to avoid screaming and yelling. But an unfortunate side effect is that parents often feel they are constantly walking on eggshells. They avoid difficult conversations because they are afraid of triggering eating disorder behaviors. This makes perfect sense. But when we avoid difficult conversations we almost always make the situation worse, not better

Because avoiding hard conversations separates us from the people we love. Also, avoiding tough conversations makes screaming and yelling more likely (not less) because complaints and disagreements get pent up and then inevitably erupt in unhelpful ways. This is a very common pattern that we frequently see in families with eating disorders.

The solution to avoiding yelling and screaming during eating disorder recovery is not to avoid difficult conversations, but to have difficult conversations more often, in a better way.

The cycle of repression 

If you’re like most parents, then your child does stuff that drives you crazy, and you want to avoid yelling and screaming. So you find yourself avoiding conversations. 

Here’s how it typically goes. You feel angry and you want them to stop whatever they’re doing or start doing something else. But you hold your tongue because you don’t want to risk triggering the eating disorder. 

Everything feels so charged, and your child seems too fragile. So instead of talking about it you may raise your eyebrows or make a big huffing sound, but you don’t actually address the negative behavior.

The next day, your child does it again … or does something else that drives you crazy. Again, you hold your tongue, but you start having angry conversations with them in your head. 

They are so irresponsible! They are so selfish! Just because they have an eating disorder doesn’t mean they get to treat you this way!

And then it happens again.They do something irritating and you repress your irritation to “keep the peace.”  

The pressure builds

Your anger is growing, but you feel you can’t express it. You repress your feelings. But inside you’re boiling. You blame your child for the fact that you can’t express yourself openly and honestly. You call your friend and tell her your child is “driving you crazy.” You say things like “the truth is that I’m afraid of my own kid. They’re like a ticking time bomb. I live in fear.”

And it’s true. You are living in fear. And you are getting angrier and angrier.

Every time your kid does something you don’t like, the pressure builds inside of you. Your eyebrow raises, snarky comments, and unpleasantness spread like a virus through your house. Everyone feels it. And you blame your child for the nastiness because you’re repressing your feelings to protect their feelings. To keep them safe from their eating disorder and avoid yelling and screaming.

This is a very unhealthy place to be in a relationship. You are repressing your feelings in an effort to protect your child’s feelings. But the impact is that your child feels worse, you feel worse, and everyone feels worse. Because feelings can’t be repressed forever. They inevitably leak out or, sometimes, explode into yelling and screaming. 

The good news is that there’s a very good solution to this problem. You just need to start having difficult conversations more frequently. And you need to learn how to have better difficult conversations.

emotional regulation

How to have difficult conversations

Difficult conversations take time, energy, and a lot of practice. When you first begin this practice, you may be exhausted by how often you need to have difficult conversations. And they may be very, very difficult. They may include yelling and screaming – the very thing you’re trying to avoid. You may worry that it’s not working, and you may slip back into avoiding difficult conversations.

But when you commit yourself to having difficult conversations frequently, you will notice a steady improvement over time. Soon, difficult conversations will be much less difficult for everyone. There will be less yelling and screaming. With practice and the right strategy, difficult conversations get much, much easier.

With practice you will reach a place in which you are respectful and honest about what you want and need. And your child will feel respected because you are not avoiding hard conversations to protect their feelings. Parents who commit to the practice of having difficult conversations can transform their relationship with their children.

Here’s how to handle difficult conversations: 

1. Identify how you feel

What do you notice inside of yourself? Sure, you may think your child is the problem, but look deeper. It’s OK to start at the point of blaming your child for your feelings, but don’t stay there. You need to keep digging. Identify what you are feeling, and claim your own feelings.

Feelings of anger and rage towards our children usually indicate that we are feeling insecure about something. Anger and rage frequently disguise feelings like fear, nervousness, disgust, discomfort, guilt, and shame. 

These are all serious and valid feelings that you can claim as your own. Your child may be the person who is triggering your feelings, but they are never responsible for your feelings. Your feelings are always are yours to handle.

Until you claim your own feelings, you risk blaming your child for how you feel, and that’s typically when difficult conversations go awry.

2. Make a simple and direct statement 

Often when we start a difficult conversation we overcomplicate things. We believe we have to get the other person to see things our way and agree with us. But this is not a useful way to begin a difficult conversation because the other person immediately feels manipulated and controlled. This is where yelling and screaming often begin.

Another mistake we make is criticizing or blaming the person for their behavior rather than making a direct request for what we want.

Start the conversation by making soft eye contact, using a gentle tone of voice, relaxed body language and voice, and make your intent crystal clear. Some examples: 

Old version: You never take the trash out, and I always have to ask you. It’s so disrespectful! I don’t understand why we have to go over this again and again. You say you’re going to do it and then you don’t, and it feels like you just don’t care about me or this family that has given you so much.

New version: I’d like you to take the trash out by 8 p.m. each night without me asking.

Old version: Partying won’t get you anywhere in life. Aren’t you interested in doing better? What even happens at those parties anyway? I bet there’s drinking, and you know that’s not OK with us! I mean, come on! I bet Sarah’s parents won’t even be there! And doesn’t her brother use drugs?

New version: I get it that you want to go to the party. But I’m not OK with you going.

When we claim our own feelings and make the conversation about what we want, not about their character or bad manners, we get off to a much better start.


3. Listen

If you have already had this conversation in your head ten thousand times, you are going to need to work really hard not to assume your child’s answer. It’s critical to stop talking and really listen to their answers.

Hold this statement in your mind: I am a parent who loves my kid, and listening is loving. 

It’s true: a person who feels listened to feels respected and loved. They are much more likely to do what we’re asking when they feel heard, understood, and loved.

Sometimes yelling and screaming is for a good reason: the person doing the yelling and screaming is literally trying to make you hear them. You can bring the volume down by listening before it hits high volumes.

Listen with the intent to understand, not respond. And be careful not to respond with something about them, like “you always/never do this.” Remember to claim your own feelings in this situation rather than blaming your child for how you feel.

Be willing and confident to dive as deeply as you need to in order to uncover what’s really going on for your child. Don’t assume you already know why they’re doing the irritating thing. All negative behavior comes from some unmet emotional need. They are rarely intentional or designed to hurt us. When parents seek to identify and address the emotional need, kids’ negative behaviors typically recede and get much easier to handle.

4. Prepare to repeat yourself 

As the conversation progresses, simply share again how you would like things to be. Don’t try to convince them of your perspective. But do look for common ground, and build on areas of agreement. Then pause and listen.

Listening more than you speak is almost always the best advice when having a difficult conversation with your child. If you’re asking them to do something they don’t want to do, then just say what it is and then listen. Then say it again and listen some more. Keep it simple and direct.

You may have to say the thing you want many times. The key is to know that this is part of parenting. It doesn’t mean your child is bad or you are bad. It just means you’re two different people. You’re asking them to do something and they don’t want to. That’s OK. Ask again!

It’s deceptively simple. You don’t have to try and convince them or get them to agree with you. Your goal is to communicate your wishes clearly and directly and make your child feel respected and heard in the process. 

Your child does not need to agree with or like your boundaries in order for you to set them! 

More conversations, less yelling & screaming

The important takeaway here is that to avoid yelling and screaming when there’s an eating disorder we don’t want to avoid difficult conversations. Instead, we want to have more difficult conversations and do them better.

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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How to talk about body image with kids

How to talk about body image with kids

Sadly, negative body image is increasingly common in kids, and at younger ages, so we need to talk about it. We live in a body-conscious society that is cruel to bodies, especially if they don’t fit a rigid belief about what it means to be healthy. This of course has a terrible impact on kids in larger bodies. And a shocking number of kids of all sizes live in constant fear of “getting fat” and believe they are “bad” when they gain weight. 

Kids have immature reasoning skills, and the fear of getting fat (which in our culture equals being “bad”) can quickly snowball into dangerous dieting and eating disorder behaviors. 

While I don’t think our kids can avoid bad body thoughts entirely in our society, they can avoid developing a negative body image if we take careful steps to help them recognize that having worries, thoughts, and fears about their bodies and fat don’t mean they have to change their bodies and behaviors. Parents can help kids feel OK in a culture that constantly tells them they are not. 

What is unhealthy body image?

An unhealthy body image means that you feel bad about your body and the way it looks. Since bodies are such an important part of how others perceive us, most people who have negative body image also have a negative sense of self. Negative body image is associated with higher rates of anxiety, depression, and eating disorders, all of which are associated with low self-worth.

Here are some heartbreaking facts about body image from a report published by the Common Sense Media Group:

  • More than half of girls and approximately a third of boys age 6-8 say their ideal body is smaller than their actual body.
  • Between 1999 and 2006, hospitalizations for eating disorders among children under the age of 12 spiked 119%.
  • By age 6, children are aware of dieting and may have tried it.
  • 26% of 5-year-olds recommend dieting as a solution for a person who has gained weight.
  • By the time they’re 7 years old, 25% of children have engaged in some kind of dieting behavior.
  • 80% of teenage girls compare themselves to images they see of celebrities and, of that group, nearly half say the images make them feel dissatisfied with the way they look.

Why do kids develop body image issues?

There’s no single reason kids develop bad body image, but we don’t need to look far to see many influences, including:

  • Parents and other adult family members who talk about the virtues of being thin, attractive, and “healthy” which is often a code word for “not fat”
  • Siblings, cousins, and peers who tease and bully larger kids and/or diet and exercise to lose weight
  • Schools that weigh students and promote calorie counting programs
  • Coaches and sports programs that conduct weigh-ins and assign tight-fitting, body-conscious uniforms
  • Doctors who discuss weight as a problem in front of children during pediatric visits
  • Media, ranging from billboards and magazines at the supermarket checkout to movies and social media that objectify bodies and promote a narrow body ideal

The seeds of bad body image are literally everywhere in our culture. Sadly, we cannot protect our kids from many of the negative messages about bodies. But we can counteract them by talking about body image and upholding strong boundaries at home. 

How can I help my child with body image issues? 

Parents have a lot of influence over a child’s body image. We can’t protect them from the vast cultural forces of weight stigma and diet culture. But we can set boundaries and have difficult conversations in our own homes to reduce the chances of our kids developing poor body image. 

Here are 4 steps that will help your child’s body image:

1. Work on your own body image 

You do not need to have a perfect body image in order to raise a body-confident child. But you do need to be actively exploring your own body image and how you relate and respond to weight stigma and diet culture. Almost all adults have internalized fear of fat and assumptions about what makes a body “healthy.” We’ve also made assumptions about what we need to do to be “healthy.” Many of these assumptions are false. Make sure you are exploring your faulty beliefs and repairing your relationship with your own body throughout your parenting journey.

2. Talk about bodies with respect

One of the big issues we have is that bodies are treated disrespectfully. All human beings, and therefore all bodies, deserve dignity and respect no matter what they look like. This applies to fat bodies, thin bodies, and every shape and size body. Dignity and respect for our shared humanity must be a core value in your home if you want to protect your child from bad body image. Have a zero-tolerance policy for body-shaming, fat-shaming, and health-shaming. All bodies are good bodies, and all bodies deserve respect!

3. Talk about the objectification of bodies to sell things

Bodies, particularly women’s bodies, are frequently objectified and used to sell products. In my neighborhood, we have a billboard promoting condominiums that features a headless woman in a bikini. Her faceless body is being used to sell housing.

This is just one of the millions of examples of bodies being used to sell products. The endless objectification of bodies solidifies in our kids’ immature minds the idea that bodies are objects to be manipulated and controlled rather than part of who we are as human beings – unique and deserving of dignity.

Given the ubiquity of body objectification in advertising, marketing, and media, it’s critical that you have constant conversations about body objectification. You need to consciously point out that marketers use bodies, but you perceive them as living, breathing, and essential to our humanity.

4. Tell them that their bodies will constantly change and grow

Body types are often presented as an end-state, a goal, something to achieve. But bodies are never in a steady state. Girls’ bodies change dramatically, and puberty sometimes begins as young as 8-9 years old. At this age, girls are not able to process their complex feelings about their bodies without careful and thoughtful guidance from parents.

Growth requires weight gain, and a child spends their first 18 years undergoing dramatic changes and substantial weight gain. Bodies continue to change throughout our lives. This makes sense: bodies are supposed to change! I think we forget this because we see perfectly-preserved models in the media all the time, but the average body will go through many changes throughout life. Let your kids know that their bodies are not meant to stay the same – they will continuously change, and that is healthy! 

What do you say to a child with body image issues? 

First, please make sure that you are talking about body image regularly. Don’t wait for your child to bring it up. Instead, talk regularly about body respect and maintain high standards for treating and talking about bodies as worthy of dignity, no matter what they look like.

If your child says something that indicates they have a negative body image, the most important thing is to not dismiss their feelings or try to distract them from having them. When parents avoid kids’ difficult feelings, kids internalize shame and anxiety about what is being avoided. They believe that there is something terribly wrong with them even though that’s not what parents intended. 

Whatever you do, don’t avoid, dismiss, or distract your child from body image issues. 

Your child will probably at some point tell you they hate their body or want to change their body with dieting or exercise. Here’s a simple response that you can use in almost any situation: “It sounds like you’re having a hard time right now, and that makes sense to me. Can you tell me more about what’s going on?”

Now listen and seek to really understand your child’s fears and worries. Don’t tell them they’re wrong or that their body is perfect or beautiful. Let them explore their feelings in your loving empathy (not pity). 

Keep listening!

Keep listening until your child has expressed themself and you sense that they feel deeply understood by you. Then you may want to say something like this: 

“Honey, I know it’s so hard to live in a body in our culture. There’s a lot of pressure on bodies to look a certain way. I just want you to know that I really do understand that, but at the same time, I want you to remember that your body deserves respect and love. So when bad feelings, worries, and thoughts come up, that makes sense. But let’s never make decisions about how you treat your body based on those feelings and thoughts. Your body is good just as it is. You don’t need to mess with it or try to change it. You will have bad thoughts sometimes. Please remember this always: You’re wonderful just as you are.”

How to talk to your child about body image

Ignoring body size is like trying to avoid talking about race. Adults may pretend that it doesn’t matter, but children always sense the truth, which is that how we look influences how other people treat us.

It’s best to talk about body image regularly and without euphemism, because when we don’t talk about important things, kids assume there is something bad and shameful going on. Shame, more than anything else, is a fertile breeding ground for all sorts of mental disorders.

Talk about body image!

The bottom line is to talk about body image with your child regularly. You can do this by saying things like: 

  • Bodies are presented and used in the media to sell products, but bodies are not objects – they are a vital and unique part of each person.
  • I appreciate how my body functions for me and I respect my body by treating it well and speaking about it with kindness.
  • All bodies grow and change. And while it can be confusing, it’s all healthy and normal.
  • In our family we will always speak with dignity and respect about bodies. We will not allow body shaming, fat shaming, or bullying of anyone based on their body.
  • Having negative thoughts, feelings, and worries about your body is normal, but we shouldn’t make decisions about our health based on them. Bodies should always be treated with respect and dignity.
  • Each body is important and amazing, but also everyone is much more than a body.

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

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Fear & worry in eating disorder recovery

Fear & worry in eating disorder recovery

If you have a child who has an eating disorder, then you should expect to see fear and worry. This is because eating disorders often show up with, and in response to, anxiety. Eating disorder behaviors can be an attempt to cope with anxious feelings and thoughts. And luckily, parents have a significant impact on kids’ anxiety.

But unfortunately, our instinctual responses to our kids’ anxiety can accidentally make it worse over time!

In fact, there are treatment programs in which parents of anxious kids are the only ones who are treated. That’s right: while it’s ideal if your child is also getting treatment for anxiety, it’s not a requirement for them to start feeling (and acting) better. You can do a lot to change the course of their anxiety. Anxiety is highly responsive to relationships. You will either see it grow or decrease depending on how you respond. 

What does anxiety look like in an eating disorder?

Anxiety can be a bit tricky to see without some practice. Many people who develop eating disorders have learned to cloak their anxiety with anger, sadness, fighting, and withdrawal. Here are the top signals of anxiety, fear, and worry when there’s an eating disorder:

  1. Worry about weight
  2. Fear of food
  3. Anger about rules, restriction, and efforts to control eating disorder behaviors
  4. Sadness about perceived failure and disappointing their parents, friends, etc.
  5. Fighting and negotiating about recovery steps and expectations
  6. Withdrawal, shutdown, or a refusal to talk or engage in family activities

Anger, fighting, and sadness are the most distracting versions of anxiety. And parents typically respond to them with confusion and surprise. It seems like you’re asking your child to do something that makes perfect logical sense, so why are they so upset about it? 

The key is to know that they are upset about it because their anxiety has been triggered, and one of the ways anxiety maintains control is to put out distractions from the bigger issue, which is the fact that their anxiety response is over-reactive. 

The solution if your child has a lot of worry and fear, or if they are angry, sad, fighting you, or withdrawing when they have an eating disorder, is to learn how to respond to anxiety better. 

emotional regulation

How to deal with fear and worry in eating disorder recovery

First, let’s set the table. I want you to start talking about worry, fear, and other scary feelings regularly. Have regular conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

NOTE: lots of kids hate the word anxiety. I’m going to use it in this article so you know what I’m talking about, but you may do better if you use more kid-friendly words like worry, fear, stress, anger, etc.

The most important message I’m sharing today is that worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

Demystify anxiety. It follows a predictable pattern. It’s rarely helpful to be surprised by it, try to ignore it or force it to go away. Instead, it’s best to talk about it, recognize it, and even welcome it into your life without letting it control your life.

Never threaten anxiety. Let it exist; just don’t let it run the show.

1. Expect anxiety to show up (it will!)

One of the most confusing things about having a child with an eating disorder is how resistant they can be to recovery. Even if they say they want to recover, it may seem to you as if they are not taking the action they need to recover. 

It’s important to think a bit differently. While it’s true that your child may not be taking the action they need to recover, it’s not because they don’t want to. It’s because anxiety keeps showing up and telling them it’s not safe to recover. 

Anxiety’s job is to warn us of danger and keep us from doing things that make us uncomfortable. 

But the only way to heal from an eating disorder is to feel things like fear and worry and do the thing you need to do anyway. 

The only way out is through!

So the first thing you need to do as a parent is to stop being surprised by anxiety. Start to expect it. Expect anxiety to show up every time you put food in front of your child, and lots of other times, too. 

A child who has an eating disorder typically has a hair-trigger response to even small threats. Their amygdala is highly-responsive right now. So you’re going to see anxiety a lot. Don’t be surprised; expect it.

2. Tell your child that it’s OK to feel afraid and worried sometimes (it makes sense!)

Most parents automatically respond to anxiety reactions like worry, fear, and anger by trying to shut it down or ignore it. This makes sense because your own anxiety senses danger and wants to keep you safe. I get it.

But instead, you need to face your own anxiety about your child’s anxiety head-on. Remember: the only way out is through!

When you try to debate, diminish, or ignore anxiety, it gets stronger, digging in deeper and justifying its existence as the savior.

Instead, when you see your child getting anxious, name it. Say something like “oh look, here’s some worry. It makes sense that you get worried sometimes. I get it.” 

You can replace the word “worry” with other words like sad, angry, frustrated, irritated, scared, etc. Try to find the word that makes your child feel seen, heard, and understood. This takes some practice, but you can do it!

This removes the need for the child to justify and defend their anxiety. When you remove the opportunity for debate, you take away an essential part of anxiety escalation. 


3. Remind your child that the path to feeling better is not to avoid fear but to face fear (and do it anyway!)

Once you have acknowledged that anxiety is present in the form of worry, fear, anger, etc., take some time to let your child feel that you believe them when they say they feel however they feel. 

When you sense that they “feel felt,” then you can move on to the next stage. It’s OK if you need to try this a few times. This takes practice and is almost never perfect. That’s OK!

Now you want to remind your child that feeling worried and nervous is perfectly normal, but that we can’t live our lives according to anxiety’s demands. 

Of course, this means that you should have those pre-conversations with your child about what anxiety is, how it shows up, and how you’re going to respond to it now that you know this. 

Your response to anxiety is: worry, fear, and other big feelings will show up, and that’s OK, but we’re not going to let them make important decisions about what we do and don’t do.

4. Believe that your child can learn to tolerate their fear (they can!).

One of the biggest impediments to kids learning to tolerate anxiety is that parents worry it is not possible. Here again, we recognize that your worry as a parent can impact your child’s relationship with worry. 

So come up with a mantra for facing your fears and doing it anyway. The only proven way to reduce anxiety is to train the amygdala and your thoughts to face anxiety and build up the muscles of tolerance and acceptance.

Remember that trying to avoid anxiety will make it get stronger, but facing it and doing the scary thing anyway will build the muscles that are needed to respond to anxiety appropriately. With practice, your child will do this by themself over time. But it’s very hard to do this without help and support at home.

How this looks at the dinner table

Here’s a quick scenario about how worry and fear can show up at the dinner table with an eating disorder. 

Take 1: letting anxiety run the show

  • Child: I can’t eat. I’m full. You can’t make me!
  • Parent: You have to eat! It’s important! You promised! 
  • Child: I already ate enough. You know I can’t handle more. I’ll throw up! 
  • Parent: You have to eat this food. It’s good for you. Just eat it so we can get on with life, will you?
  • Child: You gave me too much! I can tell you added butter and oil – look! It’s just sitting on top. Gross!
  • Parent: No I didn’t! It’s the same thing I make every time. I didn’t change anything!

In this scenario, the parent is accidentally engaging in a debate with anxiety. This gives the anxiety a sense of power and control. And it usually makes the situation worse, not better.

Take 2: standing up to anxiety

  • Child: I can’t eat. I’m full. You can’t make me!
  • Parent: Yeah, you often feel this way at dinner. I get it. 
  • Child: No you don’t! You don’t understand anything!
  • Parent: It seems like you’re really upset.
  • Child: Yes I am! I hate this!
  • Parent: I get it. I really do. But remember that we talked about this, and we’re not letting worry run the show anymore. Let’s put worry aside for dinner tonight and we’ll talk to it some more after we eat if we need to.
  • Child: You’re just trying to control me!
  • Parent: Yeah, I know that’s what your worry says, and I understand that’s how it feels. Like I said, let’s get through dinner and then see what worry has to say to us later. 
  • Child: that’s stupid (they take a bite).

In this scenario, the parent is not fighting with or trying to make the anxiety go away. They’re acknowledging and validating the existence of anxiety and asking the child to do the hard thing even though they feel anxious.

Practice, not perfect

This is a practice, and it takes time for parents to learn a different way of responding to anxiety. If this sounds impossible right now, I get it. But trust the process. It works.

Anxiety is one of the most common mental disorders, and we have thousands and thousands of research papers examining what it is and how it works. There is a lot of data to support this treatment approach to a child with anxiety. 

One of the things we know is that for most parents, their instinctual response to anxiety will accidentally increase a child’s anxiety over time rather than decrease it. But at the same time, when parents learn and practice new skills for responding to anxiety, they will see a decrease in anxious outbursts and behaviors. 

Anxiety is the most treatable mental disorder, and since it underlies and drives so many other disorders, including eating disorders, it makes sense to learn some new skills for responding to anxiety differently. 

Book Recommendation

This book gives an excellent overview of what anxiety is and how parents can respond differently for better results.

Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children by Reid Wilson & Lynn Lyons

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.

Posted on 2 Comments

How to handle doctor’s appointments with an eating disorder

How to handle doctor's appointments with an eating disorder

Often you need to make various types of doctor’s appointments during eating disorder recovery. Sometimes they are related to the eating disorder, sometimes not. Either way, doctor’s appointments can be very stressful when you have an eating disorder. So how do you handle it if you need to take your child who has an eating disorder to the doctor?

While doctors are driven to care for their patients, many are unfamiliar with the complexities of eating disorders. I don’t believe doctors mean harm to their patients. However, I do know doctors can accidentally cause harm by saying and doing things that encourage the eating disorder.

How doctors can go wrong with eating disorders

Here are some things that may accidentally happen during doctor’s appointments that can exacerbate an eating disorder: 

1. Automatic weigh-ins

Most doctor’s offices do an automatic weigh-in. However, this can be triggering for a person who is in eating disorder treatment and recovery. Seeing, hearing, or otherwise encountering weight gain can spark a desire to lose weight. Also, finding out about weight loss may provide a “rush” of success and entrench eating disorder behaviors even deeper. It’s common practice to avoid sharing weight information with a person who has an active eating disorder and/or is in recovery. Many people who have fully recovered from their eating disorder continue to avoid automatic weigh-ins due to their triggering nature. In a surprising number of cases, weight is not required to provide healthcare.

2. Talk about weight

Unless your child’s doctor is trained in eating disorders, they may accidentally make unhelpful comments about your child’s weight. In some cases, they may be dismissive of weight. Doctors may suggest that a child who is in weight recovery is “fine” and doesn’t need to gain more weight. Or they may become concerned if the weight recovery goal is higher than they think it should be. There are a lot of landmines when it comes to talking about weight with a person who has an eating disorder. Eating disorder recovery specialists are trained to handle the nuance of talking about weight, but most other people, including doctors, will, unfortunately, make mistakes.

✨Check out our “Don’t Talk About My Child’s Weight” cards✨

3. Talking about food as good/bad or suggesting more/less

Doctors often try to make helpful suggestions about eating. They may discuss food in terms of “healthy” and “unhealthy” choices. They may also ask about how many servings of dairy, vegetables, or other nutrients your child is consuming. While understandable, this sort of talk can be very triggering for a person in eating disorder recovery. Similarly, casual comments about eating more or less can be upsetting for a person in eating disorder recovery. Remember that while doctors are very knowledgeable about bodies and physiology, they have limited training in eating disorders and mental health. They really want their patients to be healthy. But the impact of uninformed food and diet talk can be disruptive to the process of eating disorder recovery.

4. Dismiss your concerns

Some parents bring their children to a doctor to help them diagnose and validate concerns about an eating disorder. But this can, unfortunately, backfire. Few doctors are qualified or comfortable enough to make a non-weight-based diagnosis. In other words, unless your child is at a level of medical underweight that they require hospitalization, a doctor may not recognize their eating disorder symptoms as serious. Except in specific cases, your child’s doctor may not be the best person to diagnose your child. But they can often participate in treatment in other ways. It’s just important to know what to expect. You want to avoid being in a situation in which your child’s doctor dismisses your belief that they have an eating disorder in front of your child. 

A note for parents who have an adult child: I recognize that much of this advice will not be applicable to your situation. Most adult children do not bring a parent to the doctor with them. Hopefully, this article will at least give you some ideas of things you can talk to your child about before and after they see a doctor so you can help them avoid dangerous situations and/or process them if they do occur.

How to prepare for a doctor’s appointment with an eating disorder

First, unless your doctor is specifically trained in eating disorders, you should expect to do some level of appointment preparation and management. While doctors want to care for their patients, they receive very little training about eating disorders and mental health in medical school. 

Any mistakes they make are most likely coming from the best intentions. But the outcome of any mistakes can nonetheless be serious. 

Here’s how to prepare for a doctors appointment if your child has an eating disorder:

1. Set realistic expectations

Recognize that without special training, your child’s doctor is not an expert in the treatment of eating disorders. This means that while you can of course consult the doctor for your child’s health, they may not be the best person to make a diagnosis and support you through recovery. Unless you are seeing a specialist, the best people to guide your child’s treatment will likely be a team of a psychologist and a dietitian, with possibly a psychiatrist and a parent coach. This team may ask you to get your doctor involved in checkups, but it’s unlikely that they will expect your doctor to provide guidance and care when it comes to actually treating and managing the eating disorder. 


2. Know what you’re asking for

It’s best if you’re clear about your intention for the visit. Are you looking for a general checkup? Or maybe you’re going in for something unrelated to the eating disorder like a sprained ankle or sore throat. On the other hand, you may be taking your child in for blood work and weight to assist their treatment team. Know what you are looking for, and if it’s not an appointment that is specifically designed to support your child’s eating disorder treatment team, you can let the doctor do what they’re best at, like treat that sprained ankle or sore throat, without talking too much about the eating disorder. I’m not saying you can’t talk about it, but it’s best to be clear about the purpose of your visit. Remember that visits are typically 10-15 minutes long, so it’s helpful to have a clear purpose in mind before you begin. 

3. Ask for accommodations

If your doctor’s appointments are specifically about your child’s eating disorder, then ask your child’s treatment team to either contact the doctor directly or assist you in how best to approach the appointment. If the appointment is not about the eating disorder, then you can do the following:

  • Ask that your child not be weighed or, if it’s required, to be blind weighed, making sure the weight does not appear on post-visit paperwork
  • Ask the doctor not to talk about your child’s weight during the visit. If they have any questions, direct them to you or your child’s treatment team
  • Ask the doctor not to talk about food and eating during the visit. If they have any questions, direct them to you or your child’s treatment team 

4. Anticipate stress and discomfort

Going to the doctor when you have an eating disorder is typically an emotionally stressful experience. Most people who have eating disorders are highly concerned with their health and also suffer from anxiety. It’s best if you can anticipate their stress and spend time before the appointment helping them to feel safe and connected with you. This pre-work will go a long way to supporting your child’s experience at the doctor and avoiding major trigger events. If you need some help, check out this eBook on emotional regulation.

emotional regulation

During doctors appointments with an eating disorder

During doctor’s appointments, you can advocate for your child who has an eating disorder by making sure that if weight is taken, it is not shown, discussed, or printed on aftercare materials. Additionally, you can intervene if the doctor begins a discussion of weight or “healthy” food and eating. 

If your child’s doctor is doing an assessment for your treatment team, obviously the eating disorder will be a topic of discussion. Just keep a close eye on it and try to guide the doctor if you feel they are getting into dangerous territory. Remember that you know your child best right now, and it’s OK to intervene if necessary.

Additionally, if your visit is not related to the eating disorder, you can keep the visit on-topic. While your child’s doctor should know they have an eating disorder, as long as they are getting treatment, it’s OK for the visit to focus on the sprained ankle or whatever you came in for.

Most importantly, try to keep your own emotional state regulated during the appointment. Remember that your emotional state impacts how your child feels, so do some work in advance and during the appointment to stay as regulated as possible. If you or your child becomes emotionally dysregulated during the visit, be sure to do some after-care to get you both into balance. Seek to reconnect and coregulate as soon as you can.

You can do this!

Navigating the health system when there’s an eating disorder can be really challenging. Doctor’s visits should be safe and healthy, but it’s best to prepare and remain vigilant to optimize your child’s experience given where they are right now. 

We have been trained to defer to doctors at all times, and they certainly deserve our respect. However, your first priority is your child’s recovery. You know what your child can and can’t tolerate right now, and it’s OK to speak up and politely redirect a doctor if needed.

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

She’s the founder of and a Parent Coach who helps parents handle their kids’ food and body issues.