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What to do when you are told or suspect that your child has an eating disorder, by Beth Mayer, LICSW

No parent wants to hear that their child has a problem, and eating disorders, like all mental disorders, carry a stigma that can be especially hard to handle. I wish we lived in a world in which we treated mental health disorders in the same way we do physical health. If your child had a sprained ankle, you would know exactly what to do and could trust that they were going to receive the care they needed. Unfortunately, that is not the case with mental disorders like eating disorders, so parents need to be provided with more information so they can come to terms with what’s going on and navigate the healing process.

Every person will have their own experience and their own specific needs, but there are some steps that apply to almost every parent who has just found out that their child has an eating disorder:

1. Don’t panic

A lot of times parents find out about a child’s eating disorder from teachers, friends, or coaches. Depending on the reporter who is sharing the news with you, this may not be handled very well. Ideally, we would like reporters to approach a parent with gentle compassion and some informed questions rather than abrupt and scary statements.

No matter what the reporter says, take a deep breath and ground yourself. First, address the shame storm that may engulf you with this news. Many parents notice that their first reaction is fear, shame, and judgment. Be gentle with yourself. First of all, it may not be true. Second of all, even if it is, it’s not your fault you didn’t know – most parents don’t!  People who have eating disorders typically work hard to hide the symptoms from their parents, so it is not a surprise that you needed to be alerted to a possible problem.

Ask the reporter some questions about their suspicions. For example, what have they seen or noticed? Try to get specific details if possible. This will help you as you begin doing your own investigation into your child’s health. For example, some kids who have eating disorders eat fairly normally at home but engage in their disorder everywhere else. Ask questions, and write down what you hear so that you can think about it some more. You’re likely to be in a high state of stress during the conversation, so writing things down can really help you focus and move forward.

Don’t be afraid to call the reporter back or set up a time to meet in person so that you can ask questions when you have calmed down a little more. Reporters are typically more than happy to provide as much information and support as you allow them.

I realize you may feel a lot of shame right now, but please know there is so much you can do to help your child recover if they do have an eating disorder. You didn’t cause this. It’s something that has happened, and you have tremendous power to do the next right thing.

2. Look for patterns

Once you suspect or have been told that your child may have an eating disorder, look for patterns. One of the biggest warning signals is an abrupt change in body weight. This may be a significant weight loss or gain. We live in a culture that applauds people of higher weights when they lose weight, but any weight loss in an adolescent should be considered a red flag.

Your child’s healthiest body is typically along a fairly even weight trajectory that begins at birth, and a big spike or dip is cause for concern. Be very careful about the assumptions you make about your child’s body – we live in a society that mistakenly believes that people living in larger bodies are unhealthy and that intentional weight loss is healthy. It simply isn’t true, and the more you learn about this, the better position you are in to help your child.

But eating disorders go beyond weight gain and loss. A person who has an eating disorder often has distorted beliefs about their body and food. Often a child who is heading for, or already has an eating disorder talks about hating their body. They may mention that they’re “cleaning up” their eating, which typically means removing certain foods like sugar, carbs, and animal products. These changes don’t always lead to eating disorders, but they are cause for concern.

Notice patterns during and after eating. A child who is flirting with or has developed an eating disorder may often say they “already ate,” or “aren’t hungry” at the dinner table. Or you may notice that they go to the bathroom or out for exercise immediately after eating.

Look for behavioral changes outside of eating and body size, like anxiety, defiance, and changes in who they spend time with. These signs are often not immediately identified as eating disorder symptoms, but they often occur at the same time as an eating disorder is building strength.

Overall, observe your child. See if you can notice patterns around eating, body, behavior, and mood. Notice if your child is eating more or less, losing weight, going to the bathroom after dinner, and otherwise behaving in a manner that is different than before. Write down your observations and talk to someone else – ideally a professional – before you approach your child so that you have a clear message and approach.

3. Approach with inquiry, not accusation

Eating disorders are very tricky and secretive. Parents who want to approach a child about a possible eating disorder must tread carefully and look for ways that will not be scary. This is really important, because when an eating disorder is driven further underground by poorly executed confrontation it may morph into other disorders and/or become even more embedded. It is natural for your child to become defensive, so it’s good to be prepared.

Once you have clarified patterns that are worthy of concern, you want to voice your concerns with your child – don’t wait for your child to come to you or for some other dramatic confirmation of your fears.

Rather than diving in with a direct “I think you have an eating disorder,” present some information about the patterns you have observed. Say things like “I notice you are going to the bathroom after you eat, and I’m feeling concerned.” Focus on the facts and the behaviors, not your child’s physical appearance. You don’t want to say “I’ve noticed you’ve lost a lot of weight,” but instead say “I’ve noticed that you’ve changed your eating patterns.”

The most important thing to do is to not accuse or pass blame. You need to be calm and confident when you tell your child what you have observed and state your concerns. Then listen to your child. Ask questions to open up the conversation. If your child has an eating disorder they will most likely be resistant to getting help. Eating disorders feel like lifesavers when a person is in them, and your child is probably terrified that you’re going to take it away.

Say something like “you may not feel like it’s a big deal, but we are keeping an eye on this because I am concerned because your eating patterns have changed dramatically. We want you to enjoy your body and enjoy your food, and clearly, that’s not what you’re experiencing.” Then tell your child what the next step is.

4. Get help

A good next step is a meeting with a physician. Call the physician in advance and tell them your concerns. Make sure the physician has experience with eating disorders and is informed about them. Unfortunately, few physicians have training in this area so you may need to ask for a referral to find someone who will provide a good assessment. One challenge you may face is the bias that all eating disorders look the same (i.e. underweight). Some physicians will even praise a child who has lost a dangerous amount of weight. A child who has been considered “overweight” for their whole lives, may get applause from a doctor whose only goal is to get that child into the “normal weight” range. But that is misinformed and dangerous.

You can also go to a therapist first, with the understanding that the therapist will likely recommend a physical exam as the first step in the diagnosis and treatment of a possible eating disorder. Again, you want to speak with the therapist in advance and make sure the therapist has experience with eating disorders. In both cases, you should attend the meeting with your child. Bring your list, and share your concerns in a non-accusing way.

Your child may be in the early stages of an eating disorder, or they may be what I call “fiddling.” The symptoms you are observing may be more heavily linked to anxiety or depression than a full-blown eating disorder. Regardless, immediate treatment is necessary. The earlier we start treatment for any mental distress, the better our chances of success in treatment. Your child’s eating disorder could be what I call a “blip” – it comes into your life, it’s used as a coping mechanism, and it can be treated. The longer it stays, the higher the likelihood that it will become persistent and even lifelong.

Seek support for yourself. Talk to a professional who understands body image and eating disorders. Read up about what to do and what not to do. Assess and treat your own fear as a parent. This is a tough situation for any parent. You deserve compassion and understanding. If you feel as if everyone is blaming you for the disorder, seek help immediately. You need to be treated for your own trauma in this experience.

What I really want parents to know about eating disorders is that they work. They are a very effective way for your child to deal with a tremendous amount of pain. For eating disorders to stop working, your child needs to relearn how to feel pain. Learning to go through pain is a big part of treatment. Our kids have to learn that they can tolerate pain and get through it without their eating disorder. This is entirely possible, and parents can be wonderfully helpful when they are empowered to help.


beth mayer meda

Beth Mayer, LICSW, has been working in the eating disorders field for 35 years. She has been the Executive Director of MEDA for 16 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College. She can be reached at  bethmayerlicsw@gmail.com / 617-325-1013

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Don’t blame the victim (or the parents) for eating disorders – their triggers are deeply embedded in today’s society, by Beth Mayer, LICSW

Too often, when a child develops an eating disorder, we blame the victims, the child and the parents, instead of looking at society. I think that eating disorders are much bigger than any individual, and we ignore cultural forces to the detriment of the people whom we are trying to help.

Body control is a cultural pursuit

We live in a culture that is convinced that we have the power to control almost every aspect of our bodies. With the exception of our feet and height, it is normal in our society to pursue diet and exercise with the express purpose of changing the shape and size of our body parts. When it becomes apparent that these techniques won’t work, it is not unusual to turn to surgical procedures to remove or enhance “trouble areas.”

Our culture promotes messages about the ideal “normal” body that we are supposed to control and maintain in a steady state from puberty through death, but it is impossible to achieve “normal” since it doesn’t exist. As soon as our children’s bodies start developing, they become susceptible to messages about how they can and should control their emerging body shape. This is not only emotionally harmful; it is also physically dangerous.

As far as parenting goes, from the time we give birth, mothers are talking about “getting their bodies back,” but that’s not actually normal. Just because you see it in every single magazine does not mean it is normal or possible to return to the body you had prior to having children. For many of us, as our kids hit puberty, we are hitting pre-menopause, and our bodies change again.

Body change is entirely healthy throughout our lives, but only very rarely do we hear messages about accepting our bodies as they are, and honoring them for what they can do instead of what they look like.

Notice and actively acknowledge the societal messages about changing our bodies to fit a false “normal.” Talk about the fact that what is normal is a diversity of body size and shape, and what is not normal is thinking that we should all look the same, or even that we as individuals should control and maintain the same body throughout our adult lives.

Loving ourselves feels wrong

If you are dieting, exercising or pursuing surgery to change your body, then it would appear that you don’t love your body as it is. Children have a very hard time separating the body from the self, so the message you are inadvertently sending to your child when you attempt to change your body is that you don’t love yourself. This is a role modeling behavior that suggests hatred of one’s self is more acceptable than self-acceptance and self-love.

How do you accept compliments? If someone says that you look great, do you answer with a demurring “oh, this old thing?” Or do you mention that you are trying to lose weight? Or do you ignore the compliment awkwardly? These behaviors model to our children that we are not deserving of other people’s acceptance and love. Rather than answering with “thank you! I feel great,” we demur or deflect compliments, teaching our children that it’s not OK to feel great about ourselves.

Think about how you behave towards yourself. Do you love yourself as you are? Are you happy to receive compliments just for being yourself, as you are? Consider how you can build your own sense of self-acceptance and self-love for the sake of your child’s health.

Body image impacts all of us

We typically assume that body image impacts only the females in the family, but one of the things I do as a family therapist working with a child who has an eating disorder is ask the dad about his history with his body image. It is usually surprising for the child to learn that dad most likely experienced some bullying or at least discomfort with his body during puberty. Boys can be extremely tough on each other about their body height and size and, of course, their genitals.

Many times learning about a parents’ body issues can be a valuable part of the healing process for children because they realize that they are not alone in feeling uncomfortable with their bodies. Many think that if “even Dad” felt ashamed sometimes, perhaps this disorder is larger than just me.

Talk with your child about how your own body image impacted you as a child, in adolescence, and today. Have open and honest discussions about how it feels to live in a body that doesn’t look like the ones you see in magazines, and how other people can say things that make us feel uncomfortable about our bodies.

Parents are more engaged, but kids still get eating disorders

One thing I’ve seen is that parents are becoming much more engaged in their kids’ lives, which is generally a good thing, but it can be surprising to some of them when their children still have challenges like eating disorders. I meet with a lot of parents who are wonderful parents, and they feel they have really done everything right, and are surprised to hear that their child isn’t doing perfectly well. Their children often feel shame and guilt because, given everything their parents did for them, they don’t feel they are as good as they “should” be.

Eating disorders have many contributing factors, and a parents’ behavior alone is neither the single cause nor a single protectant. One of the most important elements of eating disorder development is the child’s genetic level of sensitivity. A highly-sensitive child is much more likely to get an eating disorder, and it can’t always be prevented. And, all of the societal factors mentioned here are important as well.

There is no guaranteed way to raise a healthy, well-adjusted child because our children are their own people, and we are not in control of their life outcomes. I find that treating a child who has an eating disorder goes much more smoothly when the parents are able to accept this fact and ignore the guilt and shame that many people in our society assign to parents as the root of all problems.

Remind yourself that parenting is not an exact science, and you can be a wonderful parent and your child may still struggle in ways you hoped they would not. You do not need to look backwards and feel shame; just focus on the next steps and helping your child heal.


beth-874x1024-2

Beth Mayer, LICSW, has been working in the eating disorders field for 34 years. She has been the Executive Director of MEDA for 15 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College.

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Parents, you’re not to blame for your child’s eating disorder, but here is what you should know about it, by Beth Mayer, LICSW

First, parents should know that no eating disorder is “caused” by any single thing. Eating disorders are complex, and genetics, temperament, and environment all play a role, as do frequently co-existing conditions such as anxiety, depression, and OCD. Thus, no parent has the power to single-handedly create or prevent an eating disorder.

There are many parents who are afraid of being vilified and blamed for their child’s eating disorder. Parents are not to blame for their child’s eating disorder, but there is a lot of room for growth and education for everyone involved. When parents approach their child’s eating disorder from that place, rather than from a place of defensiveness, they are much more effective at helping their child heal.

Parents work hard to be good parents – and we have to keep working at it for life

I tell parents that of course, it’s not their fault that their child has an eating disorder, and now, what can you do from here? It’s so helpful when parents are able to bring curiosity rather than defensiveness to the situation.

As parents, we often try to educate our children, but we must remember that we need ongoing education ourselves. I’m almost 60, and I’m still learning and growing and changing. There is no magic time in our lives when we know everything, and we can always learn new things.

All parents feel we have worked hard to be good parents. And we have. All of us. And if your child gets an eating disorder and you can see ways in which you can accept that some of your choices lacked education, and if you have to learn new things and adjust your behavior moving forward, that doesn’t mean you are to blame.

We live in a fatphobic society

We live in a fatphobic society. So, of course, many parents are terrified if their child gains weight. Sometimes parents try to help their kids lose weight to help them live a better life. I get that. I understand.

Societal education tells us that dieting is the solution to being overweight, so it makes sense when parents think their kids should diet. Even though it is a well-known and scientifically accepted fact, very few people know that diets fail 95% of the time and that the most common side effect of dieting is weight gain.

My feeling around eating disorders is that the parental influence is often an accidental side effect of trying to protect their children. It’s just that you didn’t understand everything yet. Your intent to protect your child is to be applauded, but now it’s time for a new approach.

Parents (and kids) can’t expect parental perfection

As parents, we can’t expect perfection from ourselves, and kids can be taught to accept their parents’ imperfections, too. Parents and their kids need to understand that parents are humans – they make mistakes, and they have weaknesses. The fact for everyone is: you got what you got; now what are you going to do about it?

As parents, it’s very hard to know what’s right. We have to be really generous with parents. There is no perfect way to raise your children, especially around food and body.

Talking about hunger and satiety

I’d like people to talk more about hunger and satiety, and to feed themselves accordingly. I think that too often parents think about how to control their kids’ weight instead of accepting hunger and satiety. In our office, because we are so aware of these topics, we all eat at random times. There is no “right time” to eat here, because each of our bodies asks for something different, sometimes every day.

Of course, our kids are in a rigid school system, and they have very little opportunity to feed themselves this way. I think most kids don’t eat enough at school. It’s a very stressful place, and there’s very little time to eat. As a result, many kids come home from school and their bodies need another meal. When the body is hungry, we should feed it. There’s no “right time” to be eating.

Next, you can address issues such as whether a child is using food to self-soothe. If so, what skills can we teach our kids to help with their stress? They spend all day under pressure at school then they come home and feel the pressure to keep up with their homework. There’s very little time to recalibrate and relax, which the human body needs.

As parents, we can help our kids find ways to nourish their bodies and offload their stress in non-food ways. We can ask, what moves you, what excites you? We can’t change the school schedule, but can accommodate hunger and help kids manage their stress.

About recovery from an eating disorder

I warn families that many of them will gain weight. Not just the child in recovery, but the parents and siblings, too. This is a natural response to regulating eating patterns after the disorder. This is hard because the message in society is that if you’re gaining weight, something’s wrong. But learning to respect the body’s hunger and satiety, and recovering from an eating disorder, is a process, not an event. The body and mind both need time to adjust.

I tell my clients there are things they can change, but it’s unreasonable to expect dramatic changes all at once. Just because we express a desire for change doesn’t always mean we’re capable of changing. I believe in being very gentle with the process of change, and being OK with not having a map. Change is slow, it’s hard, and it can be painful.

I have found that most people who recover from an eating disorder end up healthier in body and mind than the average person. But I also tell them that they are recovering into a very disturbed world. That’s the reality. But with education and self-compassion, parents can help our children, and ourselves, navigate our current society with hope for a future where all people can feel good in their bodies.


beth-874x1024-2Beth Mayer, LICSW, has been working in the eating disorders field for 34 years. She has been the Executive Director of MEDA for 15 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College.

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For parents who are afraid that their kid is going to be fat, an interview with Beth Mayer

We live in a fat-phobic society, and I understand when parents tell me they want to protect their children from getting fat, but sometimes it seems like parents think that their main goal is to control their child’s weight when that is actually very dangerous.

I totally get that it’s hard to have a child who is heavier than the norm. I know that parents are under tremendous pressure today, and want to try to help their children succeed in all ways, including weight.

But while there are a lot of reasons for eating disorders, one thing we see consistently is that body shame usually precedes eating disorder behavior. It is a very good idea for parents to avoid trying to control their children’s bodies at any age.

These are some of the things I tell parents who are concerned about their children’s weight:

Genetics drive body size

Something you should think about really early on is the genetics in your family. If you are in a larger body, if your partner is in a larger body, if all of your relatives are in larger bodies, then it is very likely that your children will be in larger bodies. And that’s not something for you to control – that’s just your child’s genetic body type. While we’re on the topic of genetics, it’s important, regardless of where your child falls on the spectrum, never to compare siblings or relatives bodies or eating habits.

Don’t restrict food

The fact is that the more you restrict your child’s eating, the more likely they are to fight back, either by eating more or less than you think they should. I can tell you that when people feel at a young age that there are a lot of food limitations, they often feel that they want to binge more as they gain independence in life.

Talk about food

Talk about food preferences, satiety, and hunger. Talk to kids about what satiety and hunger feel like by talking. Talk about good feelings after eating, like “that was so delicious, my stomach feels so good right now, that was exactly what I wanted to eat.” This demonstrates that food is nourishing, not a reward or punishment. Don’t say things like “I feel so disgusting, I can’t believe I ate that.” Or “I’m going to have to work that off in the gym later.” Enjoy your food and help your children learn to enjoy their food. When they truly feel nourished by food, there is no need to use food against themselves.

Allow food preferences

Respect your children’s individual preferences. In addition to the fact that most of us get naturally more adventurous with age, each of us also has food preferences – foods we naturally and persistently like and dislike. Encourage children to recognize and honor their own preferences. Show that you trust your child and your child’s body even when it wants different things than yours does.

Work on yourself

Parents need to be aware of their own issues. You have to be aware of your own body and how you feel about your own body. Kids notice everything. They notice when you pull your shirt out because you feel fat. They know when you are dieting, even if you think you’re hiding it from them. You can’t shield your child from your own eating habits, so it’s important that you work on your own body relationship.

Puberty usually means weight gain

Talk to your children about what will happen to their bodies during puberty. Nobody talks about the very natural fact that most healthy bodies get rounder during pre-adolescence and adolescence. Reassure them that if they don’t fiddle with it, it will even out and end up being exactly where it’s meant to be.

Fat is not a feeling

The minute a kid says something like “I feel fat,” which can start when they are very young, ask them what they are really trying to say. Often it is actually I feel scared, I feel lonely, I feel out of control. Fat is not a feeling. What is your child really trying to tell you?

Toxic society

Take a look at the society we live in, particularly the negative body images in the media. Talk to your children and let them know that natural bodies are perfectly acceptable, and there is no need for us to feel that we must live up to the airbrushed perfection presented to us.

We live in a very disturbed society around food and body. And I’m afraid that I don’t see that going away. I think we just have to accept it, but that doesn’t mean there aren’t things we can do to help our children survive the worst of it. I believe all parents have a lot of opportunities to learn more about how to help our kids feel good about their bodies.


beth-874x1024-2Beth Mayer, LICSW, has been working in the eating disorders field for 34 years. She has been the Executive Director of MEDA for 15 years. She is nationally recognized for her clinical work with eating disorders and has spoken at conferences around the country. In addition to eating disorders, Beth specializes in treating adolescents and families. Beth has served as an adjunct professor at Simmons College, Boston University, Boston College, Lesley University and Salem State College, supervising MSW and LMHC graduate student interns. She is currently the co-chair of the NEDA network and serves on many local and national committees. Beth holds a B.S. in Clinical Psychology from Quinnipiac University and a Master of Social Work Degree from Boston College.