Dana reached out because her 11-year old child Riley recently gained weight and she’s worried that it’s due to binge eating disorder. “The last thing I want to do is shame her for her weight,” says Dana. “But how do I address the fact that I think she might be binge eating without bringing up the fact that she has actually gotten bigger?”
This is a common challenge facing sensitive, worried parents. They don’t want to make the problem worse by approaching it the wrong way. And parents are wise to be careful when a child has gained weight, particularly around puberty.
A female child in the 50th percentile for weight will gain almost 50 lbs from age 10 to 16. This weight gain may come on gradually or suddenly. A male in the 50th percentile for weight will gain 63 lbs in the same period.
All this means that significant weight gain is to be expected. But our culture is deeply fatphobic and believes that weight gain predicts poor health rather than indicates healthy growth. In this body-toxic culture, something that is natural and normal like pubertal weight gain is pathologized and questioned.
However, binge eating disorder is the most common eating disorder and can have a lasting impact on your child’s lifetime health. Weight gain alone is not an indication of an eating disorder, but if your child has gained weight combined with other symptoms, it may indicate binge eating disorder. So how can parents discern when weight gain is normal and when it indicates disordered eating?
What is binge eating disorder?
Binge eating disorder is a serious eating disorder that was only recently formally recognized by the DSM-5, which is how mental disorders are diagnosed in the United States. There are a lot of misconceptions about binge eating disorder, including:
Myth: binge eating disorder always causes weight gain
Truth: not everyone who has binge eating disorder will gain weight, and some will lose weight
Myth: people who are in larger bodies always have binge eating disorder
Truth: a small percentage of people who are in larger bodies have binge eating disorder
Myth: binge eating disorder can be overcome with willpower. Just stop eating so much!
Truth: like all eating disorders, BED is a complex mental disorder. Willpower is not the path to recovery; treatment is.
Myth: people who binge eat love food too much
Truth: many people with BED barely notice what or how much they are eating. They also feel tremendous physical discomfort and shame. This is not about “loving food.”
Myth: Binge eating disorder isn’t as serious as anorexia or bulimia
Truth: Binge eating disorder is just as dangerous as other eating disorders and can cause lifelong mental and physical health consequences.
Does Riley have binge eating disorder?
Dana reached out to me because she’s noticed that Riley has gained weight and she’s worried about binge eating disorder. But weight gain alone does not indicate that your child has an eating disorder. So the question is whether there are other symptoms of an eating disorder.
When I talked to Dana, that’s what I focused on.
“I guess the weight is my biggest concern because I’m worried about her health,” says Dana. “But it’s also how much Riley eats. She consumes way more food than her older sister. She kind of goes into a zone when she’s eating, and it’s as if she’s barely there. Then afterwards she has to lie on the floor because her stomach hurts so much. I’ve also noticed that she sneaks food into her bedroom. Then she takes the empty packages all the way out to the big trash can in our driveway rather than putting them in her bedroom trash can or our kitchen trash can.”
Now we’re starting to see the behavioral patterns of binge eating disorder. Looking through the lens of a mental disorder vs. a weight-based disorder, we start to see that Riley may be numbing out while eating, feeling compelled to eat, and feeling shame about eating, as evidenced by her habit of sneaking food and trying to hide the evidence.
What are the behaviors of binge eating disorder?
Every person who has an eating disorder has slightly different behavioral and emotional patterns, but generally we’ll see at least some of the following behaviors:
- Eating large quantities of food without appearing to enjoy the food or slow down as physical fullness increases. This often results in stomach pain and discomfort after eating.
- Sneaking and hiding food. This is often a symptom of feeling compelled to eat and ashamed of the compulsion.
- Restricting food for most of the day. Many times a person with BED will try to avoid binge eating by restricting food. This sets them up for a combination of physiological and emotional binge eating at the end of the day.
- Decreased/changed levels of social interaction and signs of anxiety and/or depression. This may be partly based on their shame about eating, their desire to avoid food, and fear of being judged when eating.
While weight gain is often a parents’ biggest concern, binge eating disorder is a mental disorder. Therefore, we want to look at behavioral symptoms and emotional distress rather than weight or other physical symptoms. That said, weight gain or loss can be a physical symptom of binge eating disorder.
What to do if you suspect your child has binge eating disorder
Here are six things to do if your child has gained weight and you suspect binge eating disorder:
1. Check your weight bias
We live in a body-toxic culture filled with weight stigma. Weight stigma is the norm in our culture, but it is also unhealthy and dangerous. So evaluate whether your concerns are primarily about weight and the potential weight consequences of your child’s food behaviors. This can take some time. Don’t assume your child has an eating disorder until you are fairly sure you have detangled your fears about weight from your child’s mental health. Get some help if you need it.
2. Educate yourself
Learn about binge eating disorder and become familiar with the psychological profile and emotional symptoms. For example, your child may be highly sensitive and have a history of worry, nervousness, and anxiety. They may have a history of picky eating or food aversions. Look for persistent feelings of shame and unworthiness. You also want to think carefully about any restrictive eating patterns you’ve seen like dieting and/or cutting out foods like meat, dairy, carbs, and sugar.
3. Take notes
Write down the behavioral symptoms you see. Take note of your child’s food and eating behaviors as well as other signs of mental health or disordered thinking and behavior. Take at least one week to document the daily behavioral symptoms you’re observing. This will help you when you reach out to a provider to help your child.
4. Learn about body image
Negative body image is involved in most eating disorders. Evaluate how your child feels about their body. Most children in our body-toxic culture feel bad about their bodies at least some of the time, but if your child is naturally in a larger body or if your family is particularly body-conscious, those are risk factors. Has anyone in your family shamed your child for their weight in the past? Are there people in your family who have been the food police and monitored or restricted your child’s eating due to weight or health concerns? Do you or your partner diet or control your weight in any way? All of these contribute to negative body image in children.
5. Get help for your child
If you believe your child has binge eating disorder, then find a non-diet eating disorder therapist or dietitian. A general provider is unlikely to have the tact and training necessary to provide a diagnosis of binge eating disorder. And a general therapist or RD could cause more harm than good. Doctors are also generally under-qualified and under-prepared to handle this well. Now that binge eating disorder is in the DSM-5, treatment is typically covered by insurance. Parents often need to fight for adequate care since this is a new diagnosis, but a good provider can help you navigate the system.
6. Get help for yourself
Weight and eating are tricky issues in our culture, and how you feel about your child’s eating and weight will make a huge impact on their ability to recover. If you only treat your child and don’t make changes in your own beliefs and behaviors, recovery will be partial at best. Find a coach, therapist, or dietitian who can help you navigate your child’s eating disorder recovery.
All eating disorders are tough to treat. This is because of the combination of biological, psychological and social factors that cause them. But when parents get educated and involved in treatment, a child is more likely to recover.
Dana is on board. “I know that sending Riley off to get treated without addressing our own issues and making changes at home won’t be as effective,” she says. “I want her to be happy and healthy, and that’s going to be a team effort.”
I’m so glad to hear her say that, and I know she’s on her way to making a positive impact on Riley’s recovery.
Ginny Jones is on a mission to empower parents to raise kids who are free from eating issues, body shame and eating disorders.
She’s the founder of More-Love.org and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.