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My child has gained weight, is it binge eating disorder?

My child has gained weight, is it binge eating disorder?

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 and a Parent Coach who helps parents navigate disordered eating, eating disorder recovery, and other challenging emotional and behavioral issues.

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TikTok is dangerous for body image and eating disorders

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

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

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

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

tiktok body image eating disorders

The danger of TikTok

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

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

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

What is TikTok?

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

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

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

What is a hashtag?

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

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

tiktok body image eating disorders

Glorification of weight loss

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

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

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

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

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

Diets and fads

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

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

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

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

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

Who is creating viral body-toxic content?

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

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

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

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

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

TikTok guidelines for parents

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

1. Set social media expectations and limits

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

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

tiktok body image eating disorders

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

2. Set up a phone contract

Some basic rules for phone use should be: 

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

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

3. Set up parental controls

You can set up the following parental controls. 

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

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

tiktok body image eating disorders

Hashtags to restrict/avoid on TikTok 

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

4. Increase media literacy

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

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

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

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

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

tiktok body image eating disorders

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

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

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

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A parents’ guide to understanding OSFED

A parents' guide to understanding OSFED

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

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

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

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

Exploring weight bias in eating disorder treatment

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

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

Medical News Today

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

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

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

OSFED: a misunderstood eating disorder

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

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

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

A lack of understanding

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

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

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

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

Behavioral symptoms of eating disorders

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

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

Emotional symptoms of eating disorders

Here are the emotional symptoms of most eating disorders:

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

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

What to do if you suspect OSFED

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

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

Catching up with Renee

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

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

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

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

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

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What purpose does an eating disorder serve?

Meaning, purpose, and eating disorder recovery

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

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

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

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

Meaning, purpose, and eating disorder recovery

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

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

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

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

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

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

Weight control

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


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


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


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

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

Finding purpose outside an eating disorder

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

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

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


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


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


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


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


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


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

Getting started

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

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

Bringing it to Sadie

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

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

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

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

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

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Childhood eating disorders: rates, risks, and treatment

Childhood eating disorders: rates, risks, and treatment

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

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

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

Types of eating disorders in childhood

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

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

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

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

What are common eating disorder risk factors?

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

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

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

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

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

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

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

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

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

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

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

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

What parents should do about childhood eating disorders

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

If you want to prevent eating disorders: 

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

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

If you suspect an early eating disorder: 

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

If your child has been diagnosed with an eating disorder: 

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

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

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

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Eating disorders in children: symptoms, evaluations & treatments

Eating disorders in children: symptoms, evaluations & treatments

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

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

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

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

What are the common symptoms of eating disorders in children?

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

Here are some signs that a child has an eating disorder

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

Quiz: does my child have an eating disorder?

Eating disorder symptoms in kids

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

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

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

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

Relationship with food: 

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

Relationship with weight and body image: 

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

Relationship with exercise:

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

Eating disorders in children: medical testing and diagnosis

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

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

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

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

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

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

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

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

Binge-type eating disorder symptoms 

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

Restrictive-type eating disorder symptoms

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

Purge-type eating disorder symptoms

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

Exercise-based eating disorder symptoms

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

Body image eating disorder symptoms

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

Combined type symptoms

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

Eating disorders in children: how a diagnosis is made

People who can diagnose an eating disorder include: 

  • Medical doctor
  • Registered dietitian
  • Psychotherapist 
  • Psychiatrist

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

Eating disorders in children: how treatment is prescribed

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

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

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

See our directory of HAES®-aligned providers

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

Eating disorder or disordered eating?

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

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

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

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

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

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

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.

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. 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. If you’d like some personal support and coaching with this issue, please contact me.

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

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

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

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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 and the doctor is not an eating disorder specialist, 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 issues, body shame and eating disorders.

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

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What are eating disorders anyway?

What are eating disorders anyway?

Eating disorder definitions are typically clinical and boring, but the truth is that eating disorders are complex and multi-layered. The people who develop eating disorders are worthy of so much compassion and love. I hope this article brings some color to the conversation and helps you understand eating disorders more clearly.

I’m sharing all my knowledge of decades living with an eating disorder and several years in full recovery. I’ve built on my own experience with many years spent researching and studying eating disorders. And I’ve also interviewed hundreds of professionals who treat eating disorders, people who have eating disorders, and parents who have kids with eating disorders.

From my perspective, the information currently available about eating disorders is clinical, dispassionate, and biased. These rigid clinical diagnoses and behavioral descriptions of eating disorders keep us locked in place. We miss the larger truth of why eating disorders occur and what comprehensive treatment looks like.

What follows is a wholehearted description of how I see eating disorders right now. This is personal but also factual. I’m not going to give you a boring, dispassionate account of the technicalities of eating disorders. Rather, this is an attempt to share the human reasons we suffer. And, hopefully, how we can find our way to recovery.

Remember that each eating disorder is unique. Therefore, this article is just one lens through which to view eating disorders.

What is an eating disorder?

An eating disorder is a set of beliefs and behaviors that disrupt a person’s relationship with food and their body. It is a mental disorder that includes obsessive and compulsive thoughts and behaviors, including*:

Body Thoughts:

  • I need to weigh less and eat less
  • If I control my weight/body I will be good
  • There are good and bad foods
  • People who eat/weigh too much are bad
  • If I don’t control my weight/body I’m bad

Eating Behaviors:

  • Eating too little/too much
  • Purging
  • Compulsive exercise
  • Measuring/counting food
  • Following a strict food plan
  • Banning major food staples (e.g. carbs, fat, meat)
  • Ignoring physical signs of hunger/fullness
  • Lying about and hiding disordered food behaviors

*These beliefs and behaviors apply to most eating disorders except ARFID

We live in a disordered eating culture. Therefore, sometimes I think the best way to define an eating disorder is to define the opposite. So here’s my definition of a non-disordered approach to eating and weight:

Someone who does not have an eating disorder believes their body is fine as it is. They trust their hunger and fullness cues. And they follow their appetite rather than a set of rules about what to eat, how much to eat, etc. While they don’t necessarily “love” their body, they accept it and treat it with respect. They pursue their own individual health holistically (body & mind) without weight goals or expectations.

Who gets eating disorders?

The common belief is that eating disorders impact white, wealthy teenage girls. However, we know that eating disorders impact people of all ages, genders, race, and socioeconomic status. Our stereotypes about what eating disorders look like make it harder for both professionals and parents to recognize an eating disorder. 

Eating disorders don’t have a single “look.” They may look like a: 

  • 45-year-old Asian mother who has a successful career and three children. She gains and loses weight each year with the enthusiastic support of everyone around her. Her eating disorder hides in plain sight.
  • 16-year old white girl who is a vegetarian, gets straight-A’s, does cross-country running, and is medically underweight. Her doctor has told her she can’t run with the team, so she runs in circles around her bedroom.
  • 28-year old Black mother who is food insecure. She struggles to feed her two young children and herself. She is plus-sized and feels constant pressure to lose weight. 
  • 34-year-old white man who can’t miss a single day of going to the gym. He rarely eats anything other than plain oatmeal, protein shakes, and steamed chicken with vegetables. His rigid lifestyle gives him little time to socialize, and he refuses to meet friends at restaurants.
  • 12-year-old Hispanic boy who has autism and has fallen off his growth curve for both height and weight. The list of foods he will eat keeps shrinking, and he’s currently only accepting chicken nuggets from McDonald’s and baby carrots.
  • 67-year old white grandmother who maintains her age-24 figure. Her email signature includes “I’m one stomach flu away from my goal weight.” She tells her granddaughters her diet secrets regularly.
  • 14-year-old Indian girl who has always been on the chubby side. She learned to purge last year and though it hasn’t helped her lose weight, she can’t stop.

Eating disorders vary, and there is no standard “look.” It’s important that we expand our understanding of eating disorders so we can adequately diagnose and treat everyone who is suffering.

Read more about racism and eating disorders.

What causes eating disorders?

A combination of biological, psychological, and social factors contribute to eating disorder development. 


  • Genes appear to play a role in eating disorder development. There is not a single gene recognized as the cause of eating disorders. But there are numerous genes that researchers have identified as common among people who develop mental disorders. This may explain why eating disorders typically show up alongside other disorders like anxiety, depression, substance abuse, etc.
  • Epigenetics is a sort of code that triggers genetic activity. A person may have the genes that underlie mental disorders. But researchers agree that genes alone don’t cause mental disorders. Epigenetic triggers come from environmental conditions beginning in utero. They can even pass through generations in a family. It appears that epigenetics can be shaped by trauma, abuse, and neglect (physical and emotional).
  • Neuroception is a body-based sensation of being either safe or unsafe. Developed by Dr. Stephen Porges, neuroception means that neural circuits in the body distinguish safety or threat and cue the body to respond physiologically, emotionally, and cognitively. When neuroception senses emotional and physical threats, the body responds with a state of fight, flight, freeze, or shutdown. This impacts every aspect of the physical and emotional experience of being alive. A person who has an eating disorder is often living in a heightened state of threat, sensing danger in their body and mind and seeking comfort and safety in their eating disorder behaviors.


  • Anxiety is a common partner to eating disorders. Since it can be hard to spot, it may be helpful to know what anxiety looks like. In its more active form it looks like perfectionism, people-pleasing, and codependency. In its less active form it may look like procrastination, avoidance, and withdrawal. Other signs include chronic shame, stress, and worry.
  • Emotional regulation skills are likely protective against eating disorders. Emotional regulation is something children learn from parents beginning in infancy and extending through early adulthood. When adequately developed over time, a person becomes able to self-regulate. Sometimes we miss emotional developmental milestones. When this happens, a person will have trouble self-soothing and responding appropriately to everyday stress and disruption.
  • A person who has an eating disorder may believe that their identity – who they are – is based primarily on what they look like and what they do. This belief can lead a person to try and “perform goodness.” When this happens, a false self takes over and the true self is hidden in shame and unworthiness. This can happen when a family and/or society teaches a person that they need to change who they are and how they behave to be loved. Healing takes place when the true self is allowed to emerge and be loved as-is.
  • Mental disorders often appear in clusters, and eating disorders are part of a larger psychological ecosystem. Disorders that commonly show up with eating disorders are autism, attention deficit hyperactivity disorder, anxiety, depression, suicidality, self-harm, substance abuse, and obsessive compulsive disorder. These disorders should be addressed holistically. Otherwise, an eating disorder may fail to recede, morph into something else, or return after treatment.


  • Families are a child’s first social group. And family norms and structure shape how a child feels about themselves and the world. Families don’t cause eating disorders. However, family beliefs and behaviors about emotions and bodies can contribute to an eating disorder. For example, many parents are not aware of the role of emotional co-regulation. Therefore their kids may miss emotional developmental milestones. Additionally, many families accidentally enforce and encourage disordered eating. Therefore they may pass along harmful messages about food and bodies based on their own cultural training.
  • There is a strong connection between diet culture and weight stigma and eating disorders. These two conditions lay the groundwork for the thoughts and behaviors that comprise an eating disorder. Diet culture is founded in the belief that bodies can and should be weight-controlled using food restriction and exercise. Weight stigma is discriminatory acts and beliefs against people who live in larger bodies. Diet culture and weight stigma are pervasive in our culture. And they are likely the driver behind increasing rates of eating disorders in the United States. Since the BMI levels were arbitrarily lowered in 1998, the weight loss industry has grown dramatically. In 1985 the U.S. weight loss industry was valued at $10 billion in annual revenue, but today it is worth at least $72 billion.

As a culture we assume weight loss is a personal goal, but it is in fact a money-making industry.

Read about the non-diet approach to health.

  • Cultural group oppression:
    • There is evidence that people who are not heterosexual and/or cis-gender are at higher risk of eating disorders. LGBTQ+ people are chronically oppressed in our culture. And self-repression is often required to maintain physical and emotional safety in a hostile culture.
    • While eating disorders can impact anyone, females are at higher risk than males. The most likely reason for this is the cultural oppression of females in a patriarchal, male-dominated culture. The chronic objectification of the female body leads women to self-objectify. Then they naturally fall into unhealthy pursuit of the “thin ideal” or “wellness culture.”
    • People of color are much less likely to receive a diagnosis for an eating disorder. But they are at least as likely (if not more likely) to have symptoms. The trauma of living as a person of color in a white-dominant culture likely contributes to eating disorders.

Most eating disorder treatment fails to address the social aspects of the disorder. The focus is on eradicating the behaviors of the eating disorder and “fixing” the person with the disorder. But in fact we have social problems that drive and sustain eating disorders. I believe we must address the social aspects of eating disorders in order to reduce the number of eating disorders and improve treatment outcomes.

Why do people get eating disorders?

There are so many factors that contribute to eating disorders. One way to view them is as coping mechanisms. I believe eating disorders develop in response to unmanaged stress and emotional dysregulation. In our culture, stress is chronic, and many people are raised without adequate emotional regulation development. Thus, coping behaviors become essential to function within our high-pressure society. Eating disorders join shopping, gambling, gaming, sex, using drugs and alcohol, and other addictions, compulsions, and obsessions as a way to cope with life. 

An eating disorder is just another way to numb a person from the pain of being human in our society. Dieting* is constantly prescribed and weight loss is celebrated. Thus, an eating disorder often begins with a well-intentioned plan to feel better and meet societal goals. There are many false and misleading health claims associated with diet plans and weight loss. And these actively promote eating disorder beliefs and behaviors. 

While not everyone who diets will develop an eating disorder, almost all eating disorders** begin with a diet. 

*defined as any effort to lose/control weight using food and/or exercise 

**with the exception of ARFID 

What are the most common types of eating disorders?

According to research published by Hay et. al. in 2017, the rates of eating disorders are as follows:

47% OSFED. The most common eating disorder is a catch-all category called other specified feeding or eating disorder (OSFED). This category includes a mix of eating disorder behaviors.

22% BED. The second most common eating disorder is binge eating disorder. This often involves a restrict-binge cycle in which a person restricts food and then binge eats. 

19% Bulimia. This often involves a restrict-binge-purge cycle. A person restricts consuming calories for an extended period of time. Next, they eat and then seek to purge the calories consumed with vomiting, laxative use, and/or over-exercise.

8% Anorexia. This is characterized primarily by restriction and being medically underweight. It is the only mental disorder that has a BMI requirement for diagnosis.

5% ARFID. The only eating disorder that is not technically associated with a desire to lose weight. ARFID typically involves restricting food and appears to be due to sensory and emotional drivers.

While these categories may be helpful, it’s important to remember that all eating disorders are mental disorders. This means that regardless of the specific behaviors, effective treatment must get beneath the behaviors to address the underlying thoughts, beliefs, and emotional dysregulation that drives them.

A path forward

This description of eating disorders hopefully adds some flavor and nuance to what you’ve seen elsewhere. But of course each eating disorder is unique. And I can’t possibly capture the vast nature of these complex mental disorders in a single article. I hope that if you have an eating disorder, you get help and find your path to healing.

And if you love someone who has an eating disorder, please remember that there is a lot you can do to help recovery. Eating disorders are so much more than a personal problem, which means loved ones can make a significant impact.

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

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

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A letter to family about your child’s anorexia (what to say/what not to say)

A letter to family about your child's anorexia (what to say/what not to say)

When you have a child with anorexia, it may be necessary to teach family members about the eating disorder and explain what to say and what not to say, and a letter can work well for this. This is especially true if your child’s eating disorder is visible. While there are many eating disorders that are invisible, low-weight anorexia can be surprising and even distressing for loved ones to see. This can lead to unhelpful and even harmful comments.

One problem with eating disorders is that people think they understand them. After all, eating disorders appear simple: a person doesn’t want to eat because they want to be thin. But this definition misses the vast experience of having anorexia, its physical consequences, and the depth of its mental distortions. 

Anorexia, like all eating disorders, is a health condition, not a choice. It’s not something that even the most well-meaning and loving family member can talk your child out of. This is not a situation in which an intervention will likely be helpful.

In fact, often well-meaning family members accidentally make things worse, not better. Of course, all they want is for your child to feel better, but they are operating out of instinct, not knowledge. And unfortunately, instinct doesn’t typically serve us well when we’re dealing with an eating disorder.

What to tell family members about anorexia

If your child is visibly ill with anorexia, then it may be helpful to provide family members with some guidance about the illness, what to say, and what not to say. However, this should be done carefully and thoughtfully. Anorexia is a personal health condition, and you should respect your child’s right to privacy as much as possible.

I recommend you talk to your child about whether and how to talk about their condition with family members. You may want to bring in their therapist to help you address this. When an eating disorder is visible, it can be very helpful to educate family members so they don’t say the wrong thing. But we must be very aware of privacy when doing it.

There are no hard and fast rules about whether and how to do this, but it’s important to think carefully and consciously about how to proceed.

Following is an email/letter you could provide to family members if your child has agreed to this language. Of course, there are hundreds of ways to write this letter – this is just one option.

Family letter: about anorexia

Dear Family,

It’s been another crazy year, and we’re looking forward to seeing you at Marcy’s wedding this summer! Before we get together I wanted to share some information with you about Ellen’s health. I’m sharing this information with Ellen’s permission because we know you will have questions and want to do our best to address them before the wedding.

Ellen has anorexia nervosa. This is an eating disorder that we’re working hard to address with the appropriate professionals. When you see her, you may be surprised by Ellen’s appearance, and we’d like you to consider the best response when you see her since I know how much you love her and want her to be safe and healthy. 

Here’s what we’d like you to know:

Eating disorders are an illness, not a choice

It looks like there’s a simple choice to eat or not eat. But eating disorders are complex medical and psychological conditions that do not respond to simple encouragement or willpower. Treatment relies on highly-trained specialists.

When loved ones assume that eating disorders are a choice, their well-meaning comments can actually make things worse (not better). Please believe us when we say that we have explored the necessary options for Ellen’s care and that it’s more complex than most people realize. That’s why I’m sharing this letter with the family about anorexia. I know most people don’t know much about it, and I hope this guidance is helpful.

What to say when you greet a person who has an eating disorder

When you see Ellen, you may be tempted to say something about her appearance. But focusing on her appearance, positive or negative, can be harmful. So instead, say things like:

  • I’m so happy to see you!
  • It’s wonderful to catch up with you!
  • I’ve missed you! 
  • How are you?

What not to say: “You’re so small/thin/tiny/like a skeleton.” While you may think the person needs to “wake up” and see that they have a problem, comments about their appearance do nothing to reverse the trajectory of the eating disorder. In fact, they actually give the eating disorder a dopamine hit. This sort of comment will not “wake her up,” but it will “wake up” the eating disorder and give it more power (not less).

What else not to say: After getting this letter, you may find that Ellen’s appearance is healthier than you assumed it would be. You may be tempted to praise her for that. But it’s actually just as harmful to comment on her appearance positively as it is to comment on it negatively. Just stay away from appearance-based comments including: 

  • You look so healthy! 
  • You look radiant!
  • You’re glowing!
  • That dress fits you like a glove!

The bottom line is to please focus on Ellen as a person, not her body.

What to say when a person with an eating disorder doesn’t eat

Now that you know about her eating disorder, you may feel as if you need to encourage her to eat. Please don’t do this! If you find yourself distressed by her eating habits, you can say things like:

  • So what’s been going on with you lately?
  • How are you?
  • Can I share something that happened to me recently? (this should not be about food, eating, weight, or health)

What not to say: “Just eat” (or any variation). This assumes that eating is a simple choice for Ellen. It’s not. This is like telling a cancer patient that they just need to stop growing tumor cells. An eating disorder is a health problem that needs to be treated by trained health professionals. Your care and love are so helpful, but please don’t try to treat the eating disorder by convincing her to eat. 

Avoid comments like:

  • Try the cake, it’s delicious!
  • Come on, you’ve got to try this amazing hamburger!
  • Wouldn’t you like just one bite of my salad? You always liked it when you were younger!
  • You look hungry! Have a bite!
  • Let’s put some meat on those bones!

As with appearance, it’s best to focus on Ellen the person, not what she’s eating.

What to say when a person with an eating disorder is upset

At times Ellen may look sad or distressed to you. Please consider whether this is something that demands a response. While I’m sure you want to cheer her up and make her feel better, just like convincing her to eat, it’s rarely helpful. But if she is clearly upset and you believe the time is right, you could say things like:

  • Would you like to talk?
  • Weddings can be pretty stressful, huh?
  • Is there anything I can do to support you right now?

What not to say: “Come on, why are you so upset? Cheer up!” Any version of “snap out of it” is like telling her to “just eat.” It’s not going to be helpful and may be harmful. Ellen, like all people, has feelings and emotional experiences. And sometimes she may be resting her face or relaxing – just because she’s not smiling doesn’t mean she’s sad. And if she is sad, we’re working on validating and supporting her rather than asking her to suppress her feelings and move on.

What to say to me

Yes, this has been a real challenge for our family, and I appreciate the concern that I anticipate you have. Sometimes I may want to talk about it, and sometimes I won’t want to. I would really appreciate it if you would treat me fairly normally by asking the usual questions like “how are you,” without asking for details about Ellen’s health. Many times I won’t be able to answer your questions. I hope you can understand this. The greatest support you can give me is compassion without questions. 

What not to say: “Have you tried acupuncture/natural medicine/hypnosis” (or any other treatment you have in mind). Please trust that we have her professional treatment team lined up and are addressing this. I’ll ask for advice if I want it, but unsolicited advice, no matter how well-meaning it is, can be really hurtful to me right now. Some other things I’d rather you not say include:

  • Why is she doing this?
  • How long will she have this?
  • Where did this come from?
  • What’s wrong with her?
  • She looks so thin! 
  • She looks terrible!
  • Don’t all girls today have eating disorders?
  • My friend’s daughter had anorexia and she …

The bottom line is that I’m a lot more sensitive than usual right now.

We want to talk about other things

We are working hard to address this, and sometimes it’s nice to have a break. So what we would like most of all is to enjoy the wedding. For Marcy’s sake and for ours, we’d appreciate it if Ellen’s health isn’t a topic of conversation. I know you love Ellen and are concerned, but unless one of us seeks you out to talk about it, let’s just enjoy each other and the wedding itself.

Thank you so much for making it through this letter. I’m sure you can imagine it was hard for me to write. I hope it’s been helpful, and we look forward to seeing you in June!

Love, Jordan

How to send a letter to family about anorexia

If you decide that a letter is the best way to educate your family about anorexia, then you should first consider what should and should not be included. Every family is different, and every case of anorexia is unique. So you should create a letter that fits your family and unique circumstances.

Once you’ve settled on the letter’s content, you can either email it or mail it. Of course, email is much easier, and you have the added benefit of being able to send it to everyone at the same time. You may want to use the BCC field of emails, which will avoid having a long email chain of responses. While some families might want to include everyone and begin a big “Reply-all” email exchange, if you want to avoid that, you can use BCC.

Once you have sent the email, you should expect to hear back from people in some way. Depending on your family, these responses may be supportive and thoughtful. Some responses may not respect the boundaries you set out in the letter. This is fairly normal and to be expected. Remember that you are not obligated to answer questions about your child’s health or treatment.

A good response for overly-nosey emails is “Thank you so much for checking in. I know you are concerned and appreciate that. To respect Ellen’s privacy, I can’t share any details beyond what I included in the letter. Thanks for understanding!” Boundaries don’t have to be rude to be effective.

Another thing that might happen is that people might feel hurt that you didn’t tell them earlier or reach out for help from them. While understandable, this response also requires you to hold a boundary. You can say something like “I really appreciate your concern and know that you would have helped if you could. For now, we’re handling it the best we can. Thank you for your support!”

How your family responds to your letter about anorexia may be wonderful or make you feel bad. But either way, you should know that holding your and your child’s boundaries is valid and important. While of course people like to be informed, we don’t owe our family our children’s private health information. And remember: you are doing the best you can when you can. Thank you for caring for your child’s health and privacy.

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

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

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It’s not easy to get a diagnosis or be treated for an eating disorder

The problems with an eating disorder diagnosis

Getting diagnosed and treated for an eating disorder can be a problem. In our series to help parents understand eating disorders, we take a look at how the diagnosis of an eating disorder can be a challenge. This article is a great companion to the free eBook, What Kids Want Parents to Know About Eating Disorders. Please feel free to get a copy.

If you have a child who has an eating disorder, then you have probably been told that eating disorders are “complicated.” So what does that mean, and why are eating disorders considered so complicated? More importantly, how can parents help? This is Part 4 of a series about eating disorders. These four elements combine to create the complexity of eating disorders. They are:

In this article, we’ll untangle the fourth element, the eating disorder diagnosis. And we’ll take a look at how having an eating disorder diagnosis can create challenges. These are mainly due to a lack of education and understanding as well as limited care and insurance reimbursement. I’ll also provide some tips for parents who want to help their child recover.

How an eating disorder diagnosis can be a problem

There are three reasons the eating disorder diagnosis can be a problem:

  1. Misunderstood: lots of people think of eating disorders as based on vanity and having a certain “look”
  2. Low education: few people, from parents to educators and healthcare professionals, will have training in recognizing and treating eating disorders
  3. Specialized care needed: eating disorders often require multiple care providers, including medical, psychological, and nutritional

An eating disorder is not like having a physical diagnosis like a broken arm or cancer. First, many people will never receive a diagnosis. This is because we tend to misunderstand eating disorders and assume eating disorders are based on low weight. Therefore, if a child doesn’t have low weight, few people will recognize the eating disorder. Without a diagnosis, the eating disorder can dig in and become more entrenched with time. Then, once an eating disorder is diagnosed, it requires multiple care providers. These providers may or may not work together, and it can be expensive and confusing to navigate the system.

1. Misunderstood: lots of people think of eating disorders as based on vanity and having a certain “look”

Eating disorders are misunderstood. They have been portrayed as conditions that affect only young, white girls. And they are almost always presented as looking like low-weight anorexia. But low-weight anorexia is actually the least common eating disorder. And eating disorders affect people of all genders, races, and socio-economic levels.

The media presents eating disorders as primarily based on vanity or achieving a certain appearance. They are called “silly” and even “ridiculous.” Meanwhile, binge eating disorder is presented as a “food addiction” and even “gluttonous.” Bulimia is rarely presented at all because it’s generally considered shameful, even “disgusting.”

But eating disorders look almost nothing like their media presentations, and no eating disorder is a choice. It’s a serious mental disorder built on distorted thoughts and beliefs. Behavior is the symptom, not the cause.

Tips for Parents: You can help your child by learning about what eating disorders are, and what they are not. Explore your biases and assumptions about what it means to have a child who has an eating disorder. Recognize that anyone can develop an eating disorder. And weight is not the only factor to measure in terms of diagnosis and recovery.

Additionally, know that another misunderstanding about eating disorders is that the parent did something to cause it. You did not. No parent can cause an eating disorder. It’s going to make parenting even harder if you blame yourself. And I assure you that even if you made mistakes, you’re not to blame. Keep learning, and stay curious, but don’t blame yourself.

2. Low education: few people, from parents to educators and healthcare professionals, will have training in recognizing and treating eating disorders

Eating disorders are not rare, and yet there is little education and understanding about eating disorders. Part of the problem is that we have a social stigma against eating disorders, so we don’t talk about them. Medical doctors and therapists rarely receive adequate training in eating disorder diagnosis. A few hours is the norm. Teachers and coaches are seldom trained to recognize eating disorders.

This means that aside from very obvious symptoms (mainly low body weight), eating disorders can be easily missed.

Tips for Parents: Begin with yourself. Learn as much as you can about eating disorders in general and your child’s particular eating disorder. You may need to advocate for your child and protect them from biases. Some parents even say they need to fight to get their child diagnosed and treated.

For instance, you want to keep an eye out for athletic coaches who inadvertently dismiss and even encourage your child’s eating disorder behaviors. Also look for family members who encourage weight loss or food-shame. And know that therapists and doctors can miss eating disorders. All of these people mean well, but low education means that parents need to stay alert to possible mistakes.

Parents often find themselves trying to educate people about their child’s condition. This includes family members, teachers, coaches, and even healthcare providers. Parents often need to advocate for and defend their children even as they are still learning about eating disorders themselves. The lack of widespread education about eating disorders makes the diagnosis a lot harder for everyone.

3. Specialized care needed: eating disorders often require multiple care providers, including medical, psychological, and nutritional

Finally, eating disorders often require a team treatment approach. Your child may need a doctor, therapist, and dietitian. They may need to attend inpatient and/or outpatient care for a while. Unfortunately, eating disorders aren’t typically well reimbursed. Often the cost of paying for care falls on parents. This all adds up to a significant burden.

Tips for Parents: Your child needs specialized care. There are often limitations in terms of geography, access, and financial restraints. You may have to fight for insurance reimbursement. There’s not a lot of advice here other than do the best you can. If you’re able to find providers who specialize in eating disorders, that’s ideal. If at all possible, extend treatment for as long as possible. But my most important tip here is to have self-compassion for yourself. This part of care is really hard.

In other words, parents need to be vigilant with insurance providers and care providers. Unfortunately it’s necessary to work hard to ensure a child gets the best care possible. However, this comes at a cost. Parents’ emotional labor during a child’s eating disorder is significant. Therefore, consider how you can care for yourself and get care from others while you navigate your child’s disorder.

Getting help

The eating disorder diagnosis is often a problem because of the misunderstanding and stigma associated with it. It helps if you can learn about eating disorders and help your child recover. This takes effort. I hope you are able to counterbalance the work involved in supporting your child with support and care for yourself, too.

If your child has an eating disorder, you can help them recover. Parents can make a tremendous impact on recovery. So please get support to help you navigate this process. If at all possible, see a therapist or coach to help.

Books to help

These books can help you understand the eating disorder diagnosis a bit more.

Famished: Eating Disorders and Failed Care in America, by Rebecca J. Lester

An inside view of the complexities of eating disorder treatment.

Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food Through Myths, Metaphors, and Storytelling, by Anita A. Johnston PhD.

Illuminating the nature of eating disorders.

Free eBook: What Kids Want Parents to Know About Eating Disorders

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

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

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Does society cause eating disorders?

Does society cause eating disorders?

If you have a child who has an eating disorder, then you have probably been told that eating disorders are “complicated.” So what does that mean, and why are eating disorders considered so complicated? More importantly, how can parents help? In this four-part series (this is Part 3 – check back for more later) we review the four elements that are linked to eating disorder development. These elements combine to create the complexity of eating disorders. They are:

  1. Genes, Personality & Experiences
  2. Family Dynamics
  3. Societal Norms & Beliefs
  4. Eating Disorder Diagnosis

In this article, we’ll untangle the third element, societal norms and beliefs. And we’ll take a look at how society can impact, shape, and even cause eating disorders. We’ll also provide some tips for parents who want to help their child recover.

The societal norms and beliefs linked to eating disorder development

The five major societal norms and beliefs that are associated with eating disorder development are:

  1. Sexism: women are expected to be small, and men are expected to be strong
  2. Beauty standards: <5% of the population meets current beauty standards
  3. Thin ideal: thin bodies are considered “healthier” and “better” than larger bodies
  4. Diet culture: believing that all bodies can be thin and those that aren’t are doing something wrong

Our society drives unhealthy body norms and beliefs. These norms and beliefs have a significant impact on eating disorders. Think about it this way: if I’m feeling bad about my life in general, that is overwhelming and I don’t know how to solve the problem. But if I feel bad about my body, I feel as if I have control over that. I’ve been taught that if I eat right and exercise enough I can limit my risk of disease, ridicule, and unhappiness. I can increase my chances of success in this society. So of course it makes perfect sense for me to put my negative feelings and thoughts into my body, which I think I can control, rather than elsewhere.

1. Sexism: women are expected to be small, and men are expected to be strong

Eating disorders are intertwined with sexism. First, they primarily affect women, although eating disorders in men are steeply rising. And all genders suffer from the stereotypes that drive sexism. The belief that women must be small and men must be big set us up for the belief that our appearance is vital to who we are.

Tips for Parents: Take a look at your assumptions about gender. All of us make assumptions, and they were taught to us by our families, peers, and the media. But luckily we can overturn generational sexism and improve our child’s ability to live confidently.

Talk to your child about society’s beliefs and expectations of girls and women. It’s OK if you learn about this together. Start investigating whether you assume women should be small and delicate. Explore whether you prefer women to keep their voice soft, avoid being angry, and jump to take care of other people before themselves. These are deep and powerful social norms, so give yourself time to learn new beliefs and behaviors about a “woman’s place” in our society.

Also, explore society’s assumptions about boys and men. How do you feel about men being vulnerable, afraid, and sad? Talk about how we pressure girls to stay small while we praise boys to grow “big and strong.” Masculinity can trap boys and men as much as it puts women and girls in rigid gender roles.

2. Beauty standards: <5% of the population meets the current beauty standard

Our culture’s beauty standards are so rigid that fewer than 5% of people meet them naturally. Social media has embedded these standards deep into our kids’ brains. Beauty standards can drive a person to believe that if they meet the standards they will be successful, happy, and loved.

Tips for Parents: Beauty standards are perpetuated by advertising and media in order to sell products. Most of us learned what it means to be beautiful and accepted at home, school, and even the grocery store where we see magazine covers featuring striking cover models.

Consider how you have interpreted beauty standards. What standards are you holding yourself to, and why? Many beauty standards keep us pursuing goals and ideals that are simply out of reach. How do your beliefs about what is beautiful impact your daily life?

Talk to your child about beauty standards. A great vehicle for this is social media. Look at social media and consider that the algorithm prefers slender, conventionally attractive bodies. We know that social media contributes to body shame. So talk about how social media makes your child feel. Don’t threaten to take it away (which could cause serious panic!) instead use it as a vehicle for having conversations about cultural beauty standards.

3. Thin ideal: thin bodies are considered “healthier” and “better” than larger bodies

The thin ideal is the belief that thin bodies are healthier and better than larger bodies. This ideal is perpetuated in almost every arena of life, from homes to schools and doctor’s offices. It impacts all of us by making us believe that being thin is a sign of health. But health is not based on BMI, and the pursuit of thin can lead to eating disorders.

Tips for Parents: There’s a really good chance that you grew up in a household that perpetuated the thin ideal – most of us do! The thin ideal is rooted so deeply in our culture that most people don’t recognize it.

One of the best things you can do is learn about the science of Health at Every Size®. This approaches health from a weight-neutral perspective. In fact, it demonstrates that the thin ideal is a greater risk to our health than high weight.

Your child’s recovery may mean they gain weight, and it almost always means they need to let go of their belief that thinner is better. So if you learn that thin is not a requirement for health, it will help set the foundation for their recovery.

4. Diet culture: believing that all bodies can be thin and those that aren’t are doing something wrong.

Diet culture perpetuates the idea that all bodies can and should lose weight, and that it is healthy to intentionally lose weight. However, 95% of people who intentionally lose weight regain the weight, and 65% of them gain more. And unfortunately, people who diet are 15x more likely to develop an eating disorder.

Tips for Parents: The diet industry has been exploding for the past 30 years and is currently at $72 billion. It has driven the belief that all of us can and should lose weight to be healthier, happier, and more attractive. But it can really help to educate yourself about the diet industry and the culture it has created.

The fact is that 95% of diets fail. And dieting itself is unhealthy and sets us up for weight gain. Are you a lifetime dieter? It’s OK if you have dieted or tried to control your weight in the past. Most of us do! But it will really help your child recover if you can let go of diet culture and learn to accept your body. I’m not saying this is easy – it’s not! But it will definitely help.

Getting help

Society is a contributor, even a cause of eating disorders. The more you can identify and understand areas where you can counterbalance social messages, the better your chances of helping your child recover. This is hard because so much of society’s messages are hidden and hard to find within ourselves. but learning about societal untruths can help you create an environment that fosters recovery.

If your child has an eating disorder, you can help them recover. Parents can make a tremendous impact on recovery. So please get support to help you navigate this process. If at all possible, see a therapist or coach to help.

Books to help

These books can help you understand society’s messages about food and body and challenge some of the assumptions we make about health.

Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach, by Evelyn Tribole, M.S., R.D. and Elyse Resch, M.S., R.D., F.A.D.A.

An extremely popular method used to treat and prevent eating disorders.

The body is not an apology

The Body Is Not an Apology, Second Edition: The Power of Radical Self-Love by Sonya Renee Taylor

A radical and loving approach to having a body.

Free eBook: What Kids Want Parents to Know About Eating Disorders

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

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

Posted on 5 Comments

How family dynamics impact eating disorder development

How family dynamics impact eating disorder development

If you have a child who has an eating disorder, then you have probably been told that eating disorders are “complicated.” So what does that mean, and why are eating disorders considered so complicated? More importantly, how can parents help? In this four-part series (this is Part 2) we review the four elements that are linked to eating disorder development. These elements combine to create the complexity of eating disorders. They are:

  1. Genes, Personality & Experiences
  2. Family Dynamics
  3. Societal Norms & Beliefs
  4. Eating Disorder Diagnosis

In this article we’ll untangle the second element, family dynamics. And we’ll take a look at how they impact and shape eating disorders. We’ll also provide some tips for parents who want to help their child recover. I encourage you to reflect on your own family dynamics and think about how they may have contributed to your child’s eating disorder. This is absolutely not coming from a place of blame, but in pursuit of understanding.

The family dynamics linked to eating disorder development

The five major family dynamics that are associated with eating disorder development are:

  1. Low emotional literacy: don’t talk about feelings and emotions
  2. Conflict avoidance: ignore or avoid difficult conversations, walk on eggshells
  3. Poor boundaries: have trouble setting and maintaining clear interpersonal boundaries; the child may over- or under-perform for the sake of the parent
  4. Rigid and controlling: parent demands discipline and respect
  5. Chaotic: there is little structure and parent has low authority in the home

This cannot be overstated: parents are not ever responsible for a child’s eating disorder. It’s important to note that there are four major factors that appear to contribute to eating disorder development, and family dynamics are just one. Parents are neither responsible for eating disorder development nor in control of recovery. But they can make a significant impact on a child’s chances of recovery if they work to improve family dynamics and optimize the healing environment.

1. Low emotional literacy: don’t talk about feelings and emotions

There is evidence that families that have low emotional literacy or don’t talk about feelings and emotions may be more likely to have a child with an eating disorder. Eating disorders are often viewed as emotional coping mechanisms that a child adopts in order to process feelings and emotions.

Tips for Parents: Build your family’s emotional literacy. This means intentionally talking about how you feel. It will take practice and consistency to build up your vocabulary and comfort with emotions. Start by trying to describe and truly feel your own feelings at least once per day. Use words beyond just sad, mad, afraid, or happy. Next, ask your kid(s) how they feel. Ask them to describe and sit with their feeling. Make this a daily practice and it will become easier and more natural.

2. Conflict avoidance: ignore or avoid difficult conversations, walk on eggshells

Conflict avoidance is commonly associated with family dynamics that may encourage eating disorder development. This is a way for the family to avoid talking about feelings and emotions by avoiding them entirely.

Tips for Parents: Start by noticing when you avoid conflict. Do you feel irritated when your partner loads the dishwasher, but instead of saying something, you just fix it? Pay attention to how many times during the day you have a feeling or opinion and shove it down to keep the peace. Next, start to clearly and calmly tell people how you feel. In the dishwasher example, you could say, “John, it would mean a lot to me if you would load the dishwasher like this.” Similarly, if you suspect your partner is upset with you about something, say “John, it seems like you’re frustrated about something. Can we talk about it?” The more you address conflict directly, the fewer eggshells will exist in your home. And if you start with yourself, the results will feel organic and are less likely to be resisted by your child(ren)

3. Poor boundaries: have trouble setting and maintaining clear interpersonal boundaries; the child may over- or under-perform for the sake of the parent

Families that have poor boundaries may raise kids who either over- or under-perform for the sake of the parent. These children may be “parentified” in that they feel they need to take on a parental role. Or they may be enmeshed with the parent and have trouble knowing where they end and the parent begins.

Clear interpersonal boundaries arise when each person in the family feels both strong as an individual and linked to the group. But in many family systems, boundaries become blurred. This is often because the parent(s) did not grow up in families that had good boundaries. Family patterns, especially dysfunctional ones, get passed down unless they are intentionally interrupted.

Tips for Parents: Work with a therapist or coach who can help you learn healthy boundaries. This will improve your life in every aspect, and will benefit everyone in your family. As you learn to set and maintain healthy boundaries, your child who has an eating disorder will feel released from significant pressure they may have been feeling in the relationship.

4. Rigid and controlling: parent demands discipline and respect

There are two completely different parenting styles often associated with eating disorders. On the one end are rigid and controlling parents who demand discipline and respect from their children. These parents believe that children should conform to the parents’ will. They tend to minimize, ignore, or be unaware of the child’s needs.

A rigid and controlling parent tends to make children feel they don’t have a voice. As a result, they will often rebel by using dangerous behaviors. One of the greatest rebellions for children of all ages is eating or not eating to show displeasure. Feeding our children is the very first thing we do for them, and hunger is their first impetus for communication. So when a child has an eating disorder, it may be a sign that they have something to say to a parent.

Tips for Parents: Take a deep look at how you may be trying to control your child. Now take steps to stop trying to control your child through criticism and restriction. Get help, since this will be a major adjustment for you.

5. Chaotic: there is little structure and the parent has low authority in the home

On the opposite side of the spectrum are parents who tend to be chaotic. These parents impose little structure and feel they have no control over their children. The challenge is that when a parent has low authority the child feels unsafe and insecure.

Tips for Parents: If you feel your children control you or you just don’t have the energy or interest in setting limits, then take some time to learn how you can claim some authority in the home. This will take time and practice, and it’s best if you get professional support to examine why this became your parenting style and get the help you need to turn it around.

Getting help

Family dynamics are a contributor to eating disorders. The more you can identify and understand how your family dynamics are affecting your child, the better your chances of helping them recover. This is hard, deep work, but it is the area in which parents can have the greatest impact. Parents who work on themselves and their family dynamics are more likely to create an environment that fosters recovery.

If your child has an eating disorder, you may think they are the only one who needs help. But make no mistake: eating disorders impact the whole family. And parents can make a tremendous impact on recovery. So please get support to help you navigate this process. If at all possible, see a therapist or coach to help.

Books to help

These books can help you understand your child’s personality and learn how to manage it more effectively during and beyond eating disorder recovery.

The Power of Showing Up

The Power of Showing Up, by Daniel J. Siegel and Tina Payne Bryson

Helps you understand the nurturing role of parents and how it supports mental and physical health.

Hold On to Your Kids: Why Parents Need to Matter More Than Peers, by Gabor Maté and Gordon Neufeld

Learn how parents can maintain authority in kids’ lives and improve their mental health.

Free eBook: What Kids Want Parents to Know About Eating Disorders

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

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

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7 genetic, personality & experiential factors linked to eating disorders

7 genetic, personality & experiences linked to eating disorders

If you have a child who has an eating disorder, then you have probably been told that eating disorders are “complicated.” So what does that mean, and why are eating disorders considered so complicated? More importantly, how can parents help? In this four-part series (this is Part 1 – check back for more later) we review the four elements that are linked to eating disorder development. These elements combine to create the complexity of eating disorders. They are:

  1. Genes, Personality & Experiences
  2. Family Dynamics
  3. Societal Norms & Beliefs
  4. Eating Disorder Diagnosis

In this article we’ll untangle the first element, genes, personality, and experiences. And we’ll take a look at how they impact and shape eating disorders. We’ll also provide some tips for parents who want to help their child recover. I encourage you to reflect on your child’s life history and think about how these aspects of their life and personality may have combined to encourage an eating disorder.

The individual personality traits and genetic factors linked to eating disorders

The seven major genetic, personality, and experience factors that impact eating disorders are:

  1. Sensitive temperament: highly sensitive to noise, taste, touch, and more
  2. Perfectionistic: strives to do well and be the best, critical, hates mistakes
  3. Adverse experiences: divorce, trauma, surgery, accident, and more
  4. Mental disorder: anxiety, depression, ADHD, OCD, ASD, and more
  5. Low self-worth: difficulty seeing self as valuable and worthy
  6. Genetics: inborn traits, a relative who has/had an eating disorder
  7. Marginalized identities: impacts of gender, race, sexual orientation, etc.

As you probably know, parents cannot control whether and how their child recovers from an eating disorder. The only thing we can do is learn as much as possible and develop our own skills and self-knowledge so that we can help (not hurt) the process. By understanding how personality, genes, and experiences are linked to eating disorders, we can optimize our child’s chances of recovery.

1. Sensitive temperament: highly sensitive to noise, taste, touch, and more

Each person who has an eating disorder has a unique combination of factors that contribute to the disorder. For example, there is evidence that people who develop eating disorders tend to have highly sensitive personalities. This inborn temperament means they are more reactive to outside stimuli. Perhaps you have noticed they are quick to startle or hard to soothe. Maybe they refuse to wear “itchy” clothing or hate malls because they are too loud.

Tips for Parents: Consider how you can reduce stimulation, especially before, during, and after meals. Avoid pushing your child into environments that are highly stimulating. When you sense that your child is over-stimulated, help them regulate by soothing and calming them verbally, or just sit quietly next to them and take some deep breaths. If you can regulate your own nervous system, your child’s nervous system will automatically become more regulated.

2. Perfectionistic: strives to do well and be the best, critical, hates mistakes

It’s common to see perfectionistic tendencies in people who have eating disorders. For example, you may notice they hate to get a bad grade, miss a shot in soccer, or have a messy room. Perfectionistic qualities make someone highly self-critical and you may also notice they are also critical of others, especially their parents.

Tips for Parents: Help your child talk through their perfectionism. If you sense they are being self-critical, remind them that mistakes are absolutely OK. Avoid telling them what to do and how to do things, which can trigger perfectionism. Instead, focus on soothing their fear of mistakes. If they become critical of you, remind them that you make mistakes, and can always apologize for something if needed. But don’t apologize for the very fact that you make mistakes. Mistakes are normal, human, and healthy.

3. Adverse experiences: divorce, trauma, surgery, accidents, and more

Adverse experiences can take many forms, and they can create a foundation for eating disorders. It’s not the experience itself that is the problem – lots of people have adverse experiences and are fine. Adverse experiences become a problem when they aren’t managed and processed adequately.

Tips for Parents: Seek to define and understand your child’s adverse experiences. But don’t do this by asking them lots of questions, which could be triggering. Instead, recreate the event in your mind and consider how it might have felt for your child. Ask your child’s therapist to evaluate whether the event(s) may be impacting their eating disorder. If your child is suffering from Post Traumatic Stress Disorder, that will need to be treated in addition to the eating disorder.

4. Mental disorder: anxiety, depression, ADHD, OCD, ASD, and more

Eating disorders often co-exist with other mental disorders. These may or may not be diagnosed and treated. If your child has an eating disorder, it’s well worth considering whether they may have another disorder that could be interacting with their symptoms.

Tips for Parents: Recognize that many of these disorders are under-diagnosed and under-treated. If you suspect your child may have one of them, ask your child’s therapist whether there is anything they recommend. Meanwhile, keep a log of any events and behaviors that you feel may indicate that your child is on the spectrum for one of these other disorders. While your child’s current therapist may prioritize the eating disorder at this point in treatment, your notes may be helpful once the eating disorder symptoms are reduced.

5. Low self-worth: difficulty seeing self as valuable and worthy

Many people who have eating disorders struggle with self-worth. They do not see themselves as inherently worthy and pursue achievements and activity in an attempt to overcome what they see as a lack in themselves.

Tips for Parents: Find ways to reinforce the idea that your child is valuable and worthy of your love no matter what they do. This needs to be explicitly stated often and sincerely. For example, they are worthy regardless of their grades, their performance in sports, their body weight, how and what they eat, etc. Your child needs to know that you will love them even if they gain weight or eat “unhealthy” food. They will likely struggle with self-worth long after their eating disorder symptoms have reduced, so keep this up!

6. Genetics: inborn traits, typically a relative who has/had an eating disorder

There is evidence that there can be a genetic predisposition to eating disorders. This is most often identified when another family member also has/had an eating disorder.

Tips for Parents: Look back at your family tree and consider whether anyone in your family had or has an eating disorder or disordered eating. This may include an obvious case such as an aunt who was treated for Anorexia. But it could also include your brother who eats a very limited, rigid diet and exercises obsessively. Or your mother who was on one diet after another her whole life. Remember that your male relatives are almost as likely to have disordered eating and exercise patterns as your female relatives. Finally, consider your own relationship with eating and body image.

7. Marginalized identities

It’s important to note that there are special considerations for people who have marginalized identities based on race, gender identity, sexual identity, disability, (high) weight, etc. Someone who has a marginalized identity is at higher risk of eating disorders and also tends to have a hard time within the traditional eating disorder treatment paradigm, which is primarily oriented towards people who are white, thin, female, heterosexual, cisgender, etc.

Tips for Parents: If your child is in a marginalized identity, it is especially important that you pay attention to how their identity has shaped their experiences and personality. If at all possible, seek treatment that specifically identifies an understanding of your child’s marginalized identity.

Getting help

Personality, genes, and experiences are all linked to eating disorders, and your child will need help understanding them to recover. Therefore, parents can help kids recover by becoming aware of how these factors combine within their child to create an eating-disorder-friendly environment. The more you understand them, the better able you will be to support your child through recovery.

If your child has an eating disorder, you may think they are the only one who needs help. But make no mistake: eating disorders impact the whole family. And parents can make a tremendous impact on recovery. So please get support to help you navigate this process. If at all possible, see a therapist or coach to help.

Books to Help

These books can help you understand your child’s personality and learn how to manage it more effectively during and beyond eating disorder recovery.

Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, by Lisa Damour

Helps you understand stress and anxiety, which are commonly intertwined with Eating Disorders.

the highly sensitive child

The Highly Sensitive Child: Helping Our Children Thrive When The World Overwhelms Them, by Elaine N. Aron Ph.D

Explains the temperament most often associated with eating disorders.

Free eBook: What Kids Want Parents to Know About Eating Disorders

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

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