Category: Young Child With An Eating Disorder

Colleen called me in tears because her daughter Raleigh is eight years old and Colleen says “She’s too young to have an eating disorder! I can’t believe it.” I totally understand. It’s hard to believe that young kids can have an eating disorder, but in fact disordered eating can start even younger. Eating and feeding disturbances affect about 19.8% of kids ages 11-17, but some treatment programs for eating disorders start as young as age 5.  

1. Assess the behaviors

The first thing you want to do is assess your child’s eating disorder behaviors. Most people jump to conclusions about which eating disorder their child has, but it helps to review various eating disorder behaviors and consider whether they are involved in your child’s condition. 

Restriction

Most eating disorders begin with restriction. There are three main reasons why kids restrict food: 

• Highly sensitive to taste, texture, and other sensory feedback and/or how their body feels when they eat, for example, fullness, hunger, and nausea can be uncomfortable and lead to restriction. This sensitivity makes eating more stressful than it is for a less-sensitive child. 
• Negative food-based experiences. If your child has experienced a recent stomach flu including nausea, vomiting, and diarrhea, or constipation, they may have developed an aversion to eating for fear their symptoms will return. 
• Weight-loss goals. One of the biggest culprits of eating disorders is weight stigma and a fear of getting fat. 42% of 1st-3rd grade girls want to be thinner, and 81% of 10-year-old children are afraid of being fat. This can lead your child to restrict their food in an attempt to lose weight.  

Binge eating

When a body is restricted, it tends to crave food. Binge eating is often a response to a sense of being restricted. There are three main drivers of binge eating: 

• Child-led food restriction. When a child restricts their food for any of the reasons listed above, they will become fixated on food and are likely to binge eat. 
• Parent-led food restriction. When a parent restricts the type and quantity of food available to a child, particularly sweets and carbs, the child is more likely to binge eat. 
• Chaotic eating. If a child does not eat regularly and enough food throughout the day they are more likely to binge eat when food is available.

Purging

There are two main reasons kids purge: 

• Stomach discomfort. If a child binge eats, they may feel uncomfortable and over-full. This may lead them to induce vomiting in order to feel better. 
• Fear of weight gain. If a child is afraid of gaining weight, they may induce vomiting in an attempt to rid themselves of food ingested during a binge eating episode. 

Kids may also over-exercise. Typically girls will attempt to get smaller (look like a Barbie™), but boys may try to gain muscle mass (look like a superhero). They may also use body checking as a compulsive behavior. This includes looking at their body, measuring and pinching their body, and asking parents for feedback and reassurance about their body’s appearance. 

2. Assess the circumstances

Once you have an idea of which eating disorder behaviors are active and why they are there, consider any circumstances that may be contributing to the eating disorder.

Autism, ADHD

Undiagnosed and under-managed autism and ADHD can result in eating disorder behaviors. Kids who have autism and ADHD tend to be highly sensitive to their five senses as well as their internal sensations like digestion. If your child has been diagnosed with either or both, you should evaluate their treatment and symptoms and get those under control as best you can. If you have ever suspected your child might have autism or ADHD, consider getting an evaluation. There is a lot of stigma about both of these disorders, but they can be managed, and doing so can transform a child’s life. Keep in mind that females are probably just as likely to have autism and ADHD but are much less likely to be tested or diagnosed.

Anxiety, PTSD, OCD

When a child has anxiety, PTSD, or OCD, they are much more likely to have eating disorder symptoms. If your child has been diagnosed, then please check with their therapist and/or psychiatrist to ensure they are being adequately treated for these conditions. If your child has not been diagnosed but you suspect they may have a diagnosable disorder, you can get them evaluated. Not addressing these underlying factors means the eating disorder symptoms will be harder to manage.

Life events

Eating disorder behaviors are much more likely to occur when there are stressful life events. These include divorce and remarriage, job loss, financial problems, moving, changing schools, body changes like early puberty, and a major accident or natural disaster. If your family has been going through transitions or having a hard time, that doesn’t mean it’s your fault that your child has an eating disorder, but it is likely a sign that your child needs support in managing the experience.  

Bullying

If your child is being bullied about their weight, they are much more likely to attempt to lose weight. Both weight-based bullying and intentional weight loss are major risk factors for eating disorders. Weight-based bullying is very common. Unfortunately, it happens in schools, sports teams, and very often at home. Even gentle teasing by parents, siblings, and extended family members about weight can have serious consequences since we live in a deeply fatphobic culture. Consider this carefully in case you need to make some changes in your own behavior when it comes to weight. Most of us are unaware of weight stigma and how it shapes our behavior. Your child’s eating disorder is a great time to start understanding the dangers of weight stigma.

3. Find treatment

Regardless of the specific behavior and conditions, your child needs treatment for their eating disorder. There are three types of treatment to consider. 

Child-based treatment

Your child will need treatment from a team, most likely including a therapist, registered dietitian, pediatrician, and possibly a psychiatrist. These professionals can work with your child to monitor their health and determine the appropriate treatment. 

Parent-based treatment

Parent-based treatment is highly effective for childhood mental disorders. Parents are never the cause of an eating disorder, and yet parental behavior and beliefs can create an environment in which eating disorders either thrive or your child recovers. Working with an eating-disorder-trained therapist, RD, or coach can help you put a plan in place for improving your child’s home environment to optimize recovery.

Family-Based Treatment

An effective treatment for eating disorders is Family Based Treatment (FBT). This is when the parents take full responsibility for weight restoration and feeding their child. You can do FBT with the help of a specially-trained therapist. You can also work with an FBT-informed RD or coach who can guide you in a less formal approach.

4. Make some changes

Regardless of how you approach treatment, there are three essential steps you should take at home to support eating disorder recovery:

Structure feeding

It’s best if parents provide a structured feeding environment. Many families don’t eat together and it’s hard to manage everyone’s schedules. However, when parents are in charge of feeding their kids, kids do better across almost all measurements of health, including eating disorders. Learn about the Ellyn Satter method of feeding kids and get the support you need to make this happen.

Reduce household stress

All families face stressful events, but when families are chronically stressed it impacts everyone’s health. Seek guidance and advice from a therapist or coach who can help you reduce household stress levels. While you can’t change circumstances like divorce and financial strain, you can change the experience of feeling stressed by learning and teaching your child emotional regulation skills.

Respond to food and body anxiety

Most eating disorder behaviors are a response to anxiety. Learn to recognize your child’s signs of anxiety and respond effectively. Most parents either ignore or try to overcome anxiety with reassurance, but neither of these responses actually reduces childhood anxiety, and they may even make it worse. Learn about the SPACE method of responding to kids’ anxiety more effectively.

Having a young child with an eating disorder is not what Colleen thought she would be facing, but she took it one step at a time, and Raleigh is already making progress in her recovery. “I’m so happy to see glimpses of my happy little girl again,” says Colleen.

See Our Guide For Parenting a Young Child With An Eating Disorder

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. Young 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.

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.

See Our Guide For Parenting a Young Child With An Eating Disorder

Eating disorders are a serious problem, and young children are not immune to their symptoms and complications. About 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. About 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?

Children with 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
• A shrinking list of things they will eat
• Worrying about “getting fat”
• Showing fear when eating or thinking about eating
• 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 in a young child can be hard to spot, particularly since there can be a lot of weight fluctuations through various growth stages.

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.

Weight and body image: 

• Has your child suddenly started weighing themselves regularly? Do they seem obsessed with the number on the scale? You might not know this if the scale is in the bathroom. Get rid of all scales in your home and see what happens.
• 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.

See Our Guide For Parenting a Young Child With An Eating Disorder

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

Kids have immature reasoning skills, and the fear of getting fat (which in our culture equals being “bad”) can quickly snowball into dangerous dieting. This is dangerous because dieting is the leading cause of eating disorders, and even a young child can get an eating disorder. 

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

What is unhealthy body image?

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

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

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

Why do kids develop body image issues?

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

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

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

How can I help my child with body image issues? 

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

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

1. Work on your own body image 

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

2. Talk about bodies with respect

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

3. Talk about the objectification of bodies to sell things

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

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

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

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

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

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

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

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

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

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

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

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

Keep listening!

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

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

How to talk to your child about body image

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

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

Talk about body image!

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

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

See Our Guide For Parenting a Young Child With An Eating Disorder

In this personal story written by Emily Formea we learn about the link between perfectionism and eating disorders. She has some wonderful advice for parents facing similar challenges.

I struggled with an eating disorder for 10 years of my life! In fact, I suffered from multiple types throughout my decade-long war between me, my body, and my plate.

I was diagnosed with anorexia in the seventh grade. My eating disorder turned into the binge-restrict cycle as I entered college. Later, I became an obsessive dieter and restrictive eater. For as long as I can remember, I struggled with food, and for as long as I remember it was because of what it promised me.

I think there’s such a misconception around why people suffer from eating disorders. I always thought, “I must have just made up these rules in my head.” Or maybe I am wired differently for no apparent reason. But the truth was there was a very specific reason and personality profile that I possessed that kept me in my eating disorder for so long. It was perfectionism mixed with fake fairytales.

Perfectionism and eating disorders

I was a perfectionist to a tee. Organized, obsessive, and always controlling, I constantly tried to better myself, to achieve something, to feel worthy. Approval is something I sought in other people. My self-worth was based on earning straight A’s and achievements.

I was obsessed with trying to be ‘perfect’ and when diet culture entered my sights, my body became the target of my perfectionism. I later learned that eating disorders and perfectionism often go hand-in-hand.

So many people saw me a gifted kid, such a blessing, such an outstanding example of a young adult, etc. But deep down, I didn’t know how to calm down. I didn’t know how to relax, how to focus on myself and my well-being, how to not try to always fix others or fix my parents. I needed to be told that I was enough just as I was, and it wasn’t my job to always try to be perfect.

And this filtered into the way I struggled with food and my body image. I tried to ‘perfect’ my diet and my weight. My belief was that if I was perfect in all areas of my life, my parents would give me the acceptance and recognition I craved.

From a young age, social media, celebrities, TV shows, commercials, magazine covers, and more, taught me that successful, beautiful, rich, adored people in this world are thin. They don’t eat a lot and are always dieting or working out at the gym. They shoved this version of human value down my throat every second of every day. It’s so easy to fall into eating disorders when you suffer from perfectionism.

The fake fairytale of being thin

For me, perfectionism plus this fake fairytale in which success is measured by weight loss equaled eating disorders.

Eating disorders portray this false narrative where if you just lose some weight, all your problems will go right out the window! If you just lose 10 more pounds, then you’ll never be sad or feel insecure again. If you just eat fewer carbs, then people will love you and you’ll get a date to prom.

It’s this toxic mentality that got me deep into my disorder. I believed that if I was ‘perfect’ enough with my food, I would have a ‘perfect’ body and I would never feel sad. I would never feel lonely or anxious again.

This is the belief we must break to recover.

My parents were normal

My home life was normal! In fact, my dad hated diet foods or diet trends. He never let my brother or me count calories or fall into that mentality with food or body image. The only thing I believe that could have had a relationship to my food struggles and my home would have been that my mom was diabetic, so I think a small part of me always feared becoming diabetic. She was always counting her carbs or counting her sugars, and she needed to.

I don’t blame my mom! However, I think a part of me was more hyper-aware of food, calories, carbs, etc. than other kids were just because I was around it when I was growing up. But overall, my dad always wanted us to be active, but healthy and enjoy food freely! My parents never had a scale in our home. With food and body image, my parents were very safe and supportive of my brother and me! 

What I wish my parents knew

My parents have asked, “How could we have helped you? How could we have stopped it?” I think it’s challenging because my parents always felt scared to approach the subject with me. They felt like they were letting me down, they had done something wrong, etc.

I remember my mom telling me she just didn’t know what to do or how to help me when she knew I was hurting so much!

To parents, I always say, “Understand that telling your child to just eat more or telling your child to stop dieting won’t solve any problem.” I am the perfect example of that! My parents would comment on how I never ate enough or try to make me feel guilty for not having dessert with them.

I think they thought food was the core issue when in reality my core issue was my perfectionism and my low sense of self-worth or self-esteem. I wish my parents had not treated my disorder as something to whisper about or something that I was too silly to understand. Strangely, I think parents not only blame themselves, but they also don’t believe that the child knows what is going on or can help themselves.

For me, I always felt watched by my parents. My parents knew I wasn’t eating enough or was losing a lot of weight quickly, but they never came to me with that worry. They never brought up the subject with me. They never really asked me how I was doing or was I really hurting. It was more than just watching me to make sure I was eating enough, and if I wasn’t, they would make me eat more. 

My parents did the best they could

I think my parents did the best that they could! There is so little information out there for parents who have kids with eating disorders. They didn’t know how to help me or what was truly going on in my head. I would say to parents:

1. Don’t treat your child like they don’t know what’s going on. I knew I was struggling with an eating disorder. I just didn’t know how to stop it.

2. Don’t just keep pushing food into them. Try to find the root problem or pain that caused them to struggle with food in the first place.

3. Make them feel safe. That you don’t blame them for having an eating disorder. Let them know that you trust them, love them, and want to help them.

4. Never make them feel watched. I know this one is hard, but this created a separation between my parents and me. It seemed like I was always being watched or talked about, but never talked to. I felt like my parents sometimes thought I was trying to trick them or bamboozle them by not eating instead of recognizing how much pain I was enduring and how I just didn’t know how to help myself.

How I recovered

I finally recovered after battling a 10-year eating disorder in 2019 just after I graduated college. My parents were not involved in my treatment. Part of me wishes they were involved, but part of me does not. Let me explain:)

I think I would have gotten more frustrated had they been involved once I was an adult. When I recovered, it was because I wanted it for myself. I set my mind to it on my own. So I took control of my recovery. But I wish my parents had approached the subject sooner rather than me having to come to them with all this baggage from years and years!

I think just knowing that they loved me, that they were there, that they really had always tried their best, made me confident to seek treatment on my own.

What finally did help me was being open and honest with them and having them apologize for not fully understanding. It also helped that they renewed their trust in me. I know that I broke my parents’ trust by hiding food or lying about it. But when I started to recover, I needed to know that they supported me and trusted me!

I needed them to understand that I didn’t want to not eat, I just needed time to heal.

Here’s what I think kids need from parents during recovery:

• See them as trustworthy
• Help your child feel safe and supported
• Don’t act like your child brought this upon themselves
• Give them time to heal
• Don’t speak about eating disorder recovery as if it’s really as simple as just eating more
• Help them feel seen and heard
• Listen with an open heart
• Don’t get frustrated

My parents definitely did the best they could. And their support once I entered recovery was important! I’m so glad to be on the other side of my eating disorder now.

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Emily Formea is the founder of Sincerely, XO Emily. She provides eating disorder recovery coaching specifically for people who identify as perfectionists. Her 6-week Food Freedom online course includes topics like food obsession, identity, perfectionism, and control. Her book, Gaining a Life, is her story of eating disorder recovery.

See Our Guide For Parenting a Young Child With An Eating Disorder

By Ariel Selwyn

In the Spring of 2018 my 13-year-old daughter wanted to “eat healthy.” There is nothing wrong with eating healthy, I thought. I am a certified health coach and am a huge advocate of eating healthy. My daughter began reading food labels on some things and I thought, I’ll keep an eye on that. This went on for a few months with no other signs of anything unusual.

Until, one day we were riding in the van with my daughter and her two younger siblings and the two littles asked if we could grab some lunch. I happened to look in the rearview mirror at the same time. My daughter had a look of fear come over her face. That’s the instant I knew that something more serious was going on. I made a mental note to talk to her later that day.

Later on I asked her, “are you just wanting to eat healthy or do you feel guilt or shame when you aren’t able to eat a certain way?” She burst into tears. Yep, this was more serious than I had originally thought. I told her I would get her professional help and not to worry. We would handle this and it would be ok.

She said that she didn’t feel fat, but she was afraid to eat certain foods and she wasn’t sure what was happening. She said she would feel out of control sometimes with food and feel the need to exercise in her room to make up for it. I knew these feelings all too well, as I had battled an eating disorder myself.

I Googled professional help in the area and the closest I could find that looked like an appropriate place that also took our insurance was a center in Northern VA, about an hour and a half from our house. I made an appointment right away. It took a few weeks to get my daughter seen and in the weeks leading up to the appointment I found out there were days that she was only eating cucumbers and blueberries. I began to sit with her at every meal to make sure she was taking in food. At this time my daughter obliged as long as I was there sitting with her.

Finally, our appointment came and after several hours of many thorough questions we admitted my daughter to an intensive outpatient program which was an all-day program six days per week. It was exhausting with the traffic and the long drive on top of work, but it was worth it. My daughter was there for about a month.

However, things snowballed as the eating disorder became stronger and my daughter’s weight dropped as she ate less and less. She was admitted to Children’s National Hospital in Washington DC and a feeding tube was put in place. My husband and I took turns staying overnight with her. She was there for about five days and transferred from there to a treatment center in NC where she remained for four months.

During her time in NC, she was on a rigid meal plan with goals put in place by her team. If she didn’t meet those goals with food intake, they would present her with an Ensure supplement. If she didn’t intake enough by mouth of the food and/or Ensure, then the feeding tube would be put back in place. The tube went in and out at various times during the four months.

Even though we knew she needed this level of care, including a therapist, psychiatrist, primary care doctor, around the clock nursing staff, dietician and around the clock therapist assistants, she also unfortunately picked up other behaviors from being around other patients, including self-harm. Maybe this would have happened anyway. There is no way to tell. But some other patients there were engaging in self-harm, and my daughter hadn’t engaged in this previously.

My husband and I took turns traveling to NC every weekend. We took off work most Fridays to be down there as much as we could. We got special permission from her team to eat as many meals with her as possible, and I coached her through as many meals as I could, battling the lies of the ED with her.

However, once observing these new behaviors (e.g. self-harm), we decided it was time to move towards getting her home more quickly to get her away from the environment so she wouldn’t pick up any more behaviors. We also thought home would be the best environment for her.

Unfortunately, this plan backfired. Although we had come home with a meal plan and were trying to put an outpatient team in place, it wasn’t enough. Once we saw that she had lost weight in two weeks we knew something was up. We asked, and she told us she had been hiding and throwing away food without us knowing. This was partly our fault as parents for not watching her closely enough. However, there also needs to be responsibility and trust on the child’s part or it will never work. They need to want recovery or it will never be lasting.

At this point we had to admit her back to Children’s Hospital. While at Children’s Hospital they reinserted the feeding tube and said that they would not allow her to return home until she was eating 100% of all meals and snacks. She hated it at the hospital, so she obliged and was home in a week.

Unfortunately, it didn’t end there. She stopped eating again as soon as she got home, and we had to re-admit her back to the treatment center in NC. She stayed there for seven months with a feeding tube the entire time other than two weeks with no food intake at all other than a couple of snacks. She seemed to have lost all motivation, and the eating disorder was stronger than ever. She shut down emotionally as well. She no longer wanted to talk to us as parents and didn’t see any point in talking to her therapist.

It was devastating and hopeless. We had family therapy and group therapy, but we weren’t getting anywhere. My husband and I were exhausted from the traveling, and I was emotionally exhausted from worrying and feeling hopeless. It was draining on the entire family. The other kids were tired of mommy and daddy being gone and didn’t understand why she couldn’t just get better. We all knew it wasn’t her fault, but it was hard to hear her say things like, “I don’t want to recover” when we were trying so hard.  

After around Month 5, her team said that they could no longer help her and they wanted to transfer her to another facility. This was like a punch in the stomach. How long would this go on? They wanted to transfer her to another state even further away. How would we handle that? It was already so stressful on the family. We have three other children.

Although the two-month process of submitting applications to one treatment center after another was long and difficult, we are overall thankful that one door closed after another as far as the long-distance facilities were concerned. After the long wait, a spot opened up closer to home in Northern Virginia, only a little over an hour away.

The transfer was difficult and there were many adjustments that had to be made, but we are thankful that she has opened up to us again and gained some motivation. We are thankful that she began to take in food by mouth again.

It wasn’t all rainbows and sunshine. After only one day in the eating disorders unit, she had a self-harm episode and had to be transferred to the mental health unit for two weeks. Thankfully, she hated this unit so much that it was enough motivation for her to stop the self-harm, at least for now. We are thankful for this improvement. This facility is not perfect. We have had some issues with the nurses and director not being kind and we have had to address this. However, there have been positive things that have come out of it like my daughter getting some motivation back and her clicking with her therapist.

It has been  a long journey. It is so hard when the eating disorder takes over and you have to hear your child say they don’t want recovery. My heart would break when I spoke to my daughter, and I couldn’t fix it for her. My heart breaks when she is sad, and overwhelmed and scared and hopeless and I can’t make it all better. My heart breaks that there are treatment centers all over the US and even worldwide because our children are suffering with this and there are children out there not getting the help they need.

If you have a child who is suffering, please get them professional help and know that you are not alone as a parent either. They need you. They need to know that you are there for them without judgment. They need to know that it isn’t their fault because they didn’t ask for it and they don’t know what is happening to them.

There are times that I am not proud of. There are times that I let my frustration and exhaustion get the best of me. There are times I forgot that it was the eating disorder speaking and acting out and not my daughter. Looking back, I wish at those times I would have had more patience. So, for you, get help. See a therapist. You need support too. It wasn’t until towards the end I realized I needed that support too. Hugs, my friend. You can do this.

Thankfully, after trying many medications, the right dose of Lexapro was what did the trick for my daughter. She is finally home and living and eating freely. We are SO thankful to have her home again and to witness the freedom she is enjoying with food. We know that the chance for relapse is high, and I know that from my own experience as well. 

I battled my own eating disorder. Mine started in college and I relapsed multiple times as an adult. I didn’t get control of mine until my mid-thirties when I was put on the right dose of Lexapro. For more on my eating disorder story and recovery, you can find my book, Though the Mountains be Shaken. 

See Our Guide For Parenting a Young Child With An Eating Disorder

I wanted to figure out how parents can get better at recognizing whether a child has an eating disorder. Here’s what I found … 

Most people assume that people who have eating disorders are underweight, but it’s not that simple. In fact, your child’s body weight can hide an eating disorder in plain sight. The three signs of an eating disorder are a change in appearance, changes in eating habits, and changes in relationships.

You may think these are not specific enough. But if you know what to look for, they will tell you everything you need to know about whether your child should be evaluated for an eating disorder. 

Here’s some more information:

1. Changes in appearance

Almost all of us assume that the clearest sign of an eating disorder like anorexia or bulimia is weight loss. We also assume the sign of binge eating disorder is weight gain. These assumptions can be really dangerous, because weight may not change significantly with an eating disorder. Eating disorders are psychological and emotional in nature. Except in a very small number of cases, they are not medically recognizable. We miss the majority of eating disorders if we use weight and blood tests.

Weight loss

Weight loss or gain may occur, but many times it is not a massive change. If your child is living in a larger body, you may mistake eating disorder weight loss as positive. You may think that they are getting “healthy.” This is why it’s important to pay attention to appearance in more ways than weight. People who have eating disorders are uncomfortable with their bodies. This means that you may notice a change in the way they dress or how they hold themselves.

Clothing

They may begin to wear baggy clothing and multiple layers of clothing to hide their bodies. Some kids will change style abruptly to something darker. You may think they’re going through a simple “goth” phase. But it could also be that they are trying to show how dark they feel on the inside. Dressing in dark, strange clothing may be a signal. Other kids will show off their bodies. But they will constantly adjust their hemlines, spaghetti straps, low-cut tops, and bikini bottoms, which gives away discomfort. They may feel uncomfortable with themselves even as they appear to flaunt their bodies.

Body language

Your child may also hold themselves differently. You may notice that they tend to hold their elbow with the opposite hand. This is a classic sign of self-protection. When it takes place in a way that literally blocks the view of their stomach, it may be an indication of a lack of comfort with their body. Look for body language that indicates discomfort with the self, including slumped shoulders, lack of eye contact, and increased fidgeting. If you get the sense that your child is falling in on themselves or jumping out of their skin, it’s worth trying to understand what’s going on.

Language

They may also talk about their bodily discomfort and use phrases like “I’m so fat,” and “I’m so ugly.” Some level of body dissatisfaction is unfortunately a part of living in our culture. But consistent statements about appearance may be a sign of something more serious.

2. Changes in eating habits

The common assumption is that eating disorders are easily identified by either a drastic increase or decrease in food consumption. While this may occur, changes in eating habits are often more subtle. A small percentage of kids who have eating disorders refuse to eat. The majority of kids who have eating disorders use culturally-accepted methods of restricting food. There are many diet programs that claim that health, not weight loss, is the goal. Clean eating, Keto diets, Whole 30, Noom, Intermittent Fasting, and Weight Watchers are all excellent ways to get started with an eating disorder. About 25% of teens who go on a diet will develop an eating disorder. So any form of dietary restriction – for any reason – is cause for concern for a parent.

Popular hiding places

A popular hiding place for eating disorders today is vegetarian and vegan diets, which have become trendy among young kids. Children and teens frequently cite animal cruelty as the reason behind these dietary choices. But they are often a way to restrict food and attempt to achieve “goodness” through food choices. Eating disorder treatment centers frequently report that the majority of their patients are vegetarian/vegan.

Monitor change in your child’s eating habits. This may include:

• Eliminating favorite foods
• Following a trend-based diet
• Signing up for a weight loss program
• Tracking their intake using an app like My Fitness Pal

Disappearing food

Also pay attention to any “disappearing” food. Many people who restrict all day find themselves taking food from the pantry at night in binge eating episodes. This is a perfectly natural response to food restriction. Don’t shame your child for any binge eating. Do pay attention to disappearing food and seek professional support if you notice it consistently.

3. Changes in relationships

A sense of belonging is critical to our health. But it is rarely focused on when we talk about parenting children. When a child feels disconnected and lonely, they are more likely to have trouble. Eating disorders, self harm, suicidality, addiction, and other troubling mental conditions all stem from loneliness. An eating disorders in a young child may get triggered when they feel disconnected and lonely. Healing begins when they feel they belong and are understood.

Most parents assume that teenagers will naturally distance themselves from their families during adolescence. It’s true that some distancing is perfectly normal and healthy. However, if you or any member of your family are unable to have a conversation with your child, it could be a sign of more serious disconnection in your family.

Family is a safe place

Family is the place where a child should be able to rest as part of a loving group. Broken ties in the family relationships are dangerous for any child. Children are biologically driven to connect with their parents and families. It is not natural or healthy for them to ignore family members or be unable to relax around family members. This extends all the way into their early twenties, at which time the child will form their own “chosen families,” and the original family ties may loosen naturally.

Children and teens who have eating disorders frequently block out their parents and family members. They may stop communicating in a meaningful way with their loved ones. Kids will often also have friendship difficulties. They may fall into groups of other people who seem either aggressively “popular” or “weird.” Abrupt social changes may be a sign that your child is seeking belonging so they can feel safe and as if they belong.

What should I do if I think my child has an eating disorder?

There is no possible way that a web article can diagnose an eating disorder. If you’re reading this and your “spidey sense” is going off, it may be a good idea to do some more research and get some help.

In most eating disorder cases, there are few if any medical symptoms. Our physicians have not been trained to identify and manage mental health conditions. In fact, well-intentioned doctors can make uninformed and harmful comments. They are not trained in the subtleties of eating disorders. Nor do most know how best to approach a child who insists they are “fine” even when they are not.

This is why I recommend that if you think your child has an eating disorder you identify a trained dietitian (RD) or psychotherapist who has experience with eating disorder treatment. A nutritionist or psychotherapist who has experience with eating disorders will be able to recognize the symptoms of an eating disorder. They can help you identify the best path forward.

Look for experience

Beware of working with any professional who does not have direct experience with eating disorders. There is so much misinformation about eating disorders. Parents need to be really careful about well-meaning but uninformed professionals who can do more harm than good.

See Our Guide For Parenting a Young Child With An Eating Disorder

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Dear Ginny,

My daughter is almost 10 years old and overweight. I think she is also addicted to food.

While I like the ideas on your website, I’m still concerned about her weight and how she eats. We have a great relationship, and I feel like it’s time to address this with her directly before it gets out of control.

At the same time, I’m afraid that talking about her weight will impact her mental health. I’m also afraid that if I don’t do something about her weight it will impact her physical health.

She often overeats. She sneaks food. She loves high-fat, sugar, and carbs. I think she may be addicted – her world revolves around food. A lot of your advice is to let her body do its own thing, but what if her weight is to the point of being harmful. What should I do?

Signed, Worried Mom

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Dear Worried Mom,

I’m so glad that you reached out! I totally understand how challenging this is for parents to navigate. I want to thank you for thinking so carefully about your daughter’s health and for doing research that runs counter to everything we’ve been taught. Our cultural narratives about “overweight” and “food addiction” might come from a good place, but unfortunately, they can cause tremendous harm for our kids, including body hate, disordered eating, and eating disorders.

First, let’s address the weight issue.

We have been told two things: 1) “too much” weight is bad; and 2) we can and should reduce our body weight. Both of these are incorrect and harmful for many reasons, but here I’ll give you the highlights.

1) The concepts of “overweight” and “obesity” are based on BMI measurements, which have been shown to be inaccurate measures of individual health. Every body is different, and a higher BMI does not correlate with worse health. In fact, people who are in the “overweight” category according to BMI are slightly healthier than those at lower weights. This is shocking but true. You can find tons of data to support this in our resource library and throughout this website.

2) As hard as we try, the human body does not want us to lose weight or maintain a weight lower than what it (the body) wants to be. There is not a single scientific study showing that any weight loss efforts last, and each time we lose weight, we regain it plus more. This has a surprising impact on our lifetime body weight: those of us who diet and control our weight even once in our lives are heavier than we would be if we never lost weight intentionally.

There are tons of resources on this site to further demonstrate why your concerns about your daughter’s weight, while perfectly understandable, are unnecessary. Furthermore, if you can find a way to stop worrying about her weight, you will help her achieve the healthiest weight for her individual body.

Next, let’s talk about eating

Our society has given eating a bad rap, and everyone, our kids included, is afraid of eating to their appetite or responding to hunger with adequate food. Our kids (just like adults) get bombarded with messages about what they “should” and “shouldn’t” eat, and they internalize those messages and (understandably) become very confused with what they should actually do to nourish their bodies.

Most kids who sneak food and “overeat” are typically restricting food or being restricted by parents in some way. Sneak eating and binge eating are a natural response to under-eating. Once we start to feed out kids the food their bodies need (and each body needs a different amount of food), most sneak eating issues disappear unless there is a full-blown eating disorder and additional treatment is needed.

This may seem strange since most people assume we need to control and restrict food, but in fact, what we really need is to be free from restrictive food thoughts and behaviors.

When all foods are allowed, and our body is nourished and allowed to exist without being policed, we eat and grow according to our own biological patterns. This may mean that we grow into a larger body than we want (based on societal “beauty” standards), but we actually don’t have a choice – our bodies will find a way to weigh what they want to weigh!

Think about it this way: if your daughter were growing really tall, would you worry about what she is eating, or would you just assume that’s what her body is supposed to do?

Height and weight are both largely pre-programmed, so it’s not crazy to compare these two.

Please consider reading Your Child’s Weight: Helping Without Harming, by Ellyn Satter, which I think will answer a lot of your questions about how to proceed. It may help to reach out to a non-diet dietitian for at least one meeting to discuss your child’s eating.

I know that you can help your daughter regain body trust and grow according to how her body is supposed to. I understand this is not easy advice, and I send you so much love as you pursue this journey with her. 

Sending Love … Ginny

See Our Guide For Parenting a Young Child With An Eating Disorder

by Beth Mayer, LICSW

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

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

1. Don’t panic

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

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

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

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

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

2. Look for patterns

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

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

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

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

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

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

3. Approach with inquiry, not accusation

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

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

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

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

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

4. Get help

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

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

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

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

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

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

See Our Guide For Parenting a Young Child With An Eating Disorder

by Gillian Elizabeth

I wish we could talk about it

When I was struggling with an eating disorder my parents seemed to avoid the subject. My dad responded to people that asked about my sudden and dramatic weight loss by saying that I was on a “special diet.”

I realize this can be a tricky subject. Some parents become over-involved and obsessed about “fixing” the eating disorder. This means they talk about the eating disorder all the time, which isn’t necessarily helpful, either. I felt as if I was unseen and unheard much of the time. This is part of what fed my eating disorder.

It’s not really surprising that this environment that led me to feel unseen and unheard couldn’t change overnight when I developed an eating disorder. Of course, it takes time. But this is what I wished at the deepest level – that my parents would become intimately involved with me, and truly see what was going on and understand that I was in pain.

I was so lonely

I wish my parents could have seen my loneliness. I deeply wanted to be hugged and encouraged. In our family, physical affection and emotional intimacy weren’t natural but they were exactly what I wanted.

When I look back at my childhood, I remember constantly saying the words “play with me,” “spend time with me,” and “read to me.” I remember sitting close to people and desperately trying to get the physical affection I craved.

I understand how busy my parents were, but at the same time, I think it was more about them not noticing how lonely I was. I don’t think the time I would have taken to feel known and loved would have been that much, but it would have made all the difference in my life.

What I want parents to know

If you are a parent reading this looking for help for your child, try asking, “What do you want?” Tell your child “I recognize and accept your individuality and sense of self.” Allow your child to express who they really are and watch them blossom into the amazing human being they are.

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Gillian Elizabeth struggled with an eating disorder in High School. She learned how to truly nourish her body through intuitive eating, mindfulness, and self-love, which inspired her to become a wellness coach. In addition to her online phone and video one-on-one coaching for people who have eating disorders, Gillian is the author of Break Up With Your Diet: A 21-Day Workbook & Journal for Intuitive Eating. Visit her website here.

See Our Guide For Parenting a Young Child With An Eating Disorder

It surprises many parents to discover that children can develop eating disorders. Studies show that eating disorders are on the rise. Professionals report that the age of onset for eating disorders is younger than ever. Early detection and treatment are key.

Parents are at the frontline of eating disorder prevention and treatment, so it helps to know the risk factors of eating disorders and take action as soon as possible. Here are some important notes for parents of children and tweens about eating disorders:

Statistics about eating disorders and children

• 5 percent of adolescents are affected by an eating disorder. (National Association of Anorexia Nervosa and Associated Disorders)
• 41% of first through third graders wish they were thinner, and 81% of 10-year-olds are afraid of becoming fat. (National Eating Disorders Association)
• At least 10 percent of adults first showed obvious symptoms prior to age 10. (National Association of Anorexia Nervosa and Associated Disorders)
• The rate of development of new cases of eating disorders has been increasing since 1950. (Hudson et al., 2007; Streigel-Moore &Franko, 2003; Wade et al., 2011)
• There has been a rise in the incidence of anorexia in young women 15-19 in each decade since 1930. (Hoek& van Hoeken, 2003).

Why do children develop eating disorders?

Eating disorders are complex and cannot be blamed on any single event or situation. Historically, parents were blamed for children’s eating disorders, but that’s unfair. No parent is responsible for their child’s eating disorder. But it’s also true that parents can support either eating disorder development or recovery from an eating disorder. The causes of an eating disorder in a young child are:

1. Genetics & temperament
2. Emotional & psychological development
3. Societal forces

1. Genetics & Temperament

Family history, genetics and temperament are all key factors that underlie eating disorders. Eating disorders tend to run in families. A family history of body image and food issues may make your child more susceptible to developing an eating disorder.

Children who develop eating disorders tend to be highly sensitive. We often observe eating disorders alongside traits such as anxiety, depression, perfectionism, and conditions like ADHD and autism, which also have genetic causes. The following symptoms may indicate a mental health condition, including but not limited to an eating disorder:

• Frequent and dramatic mood swings
• Chronic fear and anxiety
• Lack of interest in activities and people that were previously enjoyable
• Repetitive and ritualistic behaviors such as grooming, cleaning, organizing, exercising, and fasting
• Change of activity level (more or less than usual)
• Sudden/drastic change of friend groups
• Significant eating restrictions, including eliminating food groups, food aversion, eating in secret and binge eating

2. Emotional & Psychological Development

A major factor in eating disorder recovery is learning to identify, process and cope with emotions. During treatment, someone in recovery will learn to process, rather than numb, emotions like anger, sadness, shame, loneliness, and envy. They will also develop self-worth and self-esteem. Parents can learn techniques to support increased emotional regulation.

In our society, we aim most articles and advice at parents of babies, toddlers, and adolescents. But the ages of 5-12 are critical in terms of emotional development. It’s common (and understandable) for parents to want a breather during this time period. But it’s important to attend to our children throughout their developmental years.

The years between kindergarten and high school are a critical time for children to learn emotional regulation skills. This is when they develop core friendships and alliances that may determine their self-worth and self-esteem. Estrangement and emotional trauma during this key period of emotional development may make a child more susceptible to eating disorders.

Therefore, parental engagement in eating disorder treatment often makes an enormous impact. Parents are critical to driving and supporting eating disorder recovery. They can also learn new techniques to help their children feel secure. Parents’ actions can help children recover.

3. Societal Forces

One thing unequivocal in the culture today is that being fat is considered bad. Our very public fear of fat is most likely a significant contributor to the increasing rates of eating disorders. Most eating disorders begin with a diet. Dieting (food restriction + exercise) is the accepted way to navigate our culture. Diets exist because being thin is synonymous with health and “goodness.”

The $70 billion diet industry drives diet culture. Tips and advice for weight loss are freely available and literally everywhere. It’s no surprise that children tend to develop eating disorders during puberty, a time when weight gain is common. They naturally turn to dieting to control their bodies.

Most kids receive diet messages and advice at home, at school, on sports teams, and in the doctor’s office. Thirty-five percent of “occasional dieters” progress into pathological dieting, (disordered eating). As many as 25%, advance to full-blown eating disorders. Despite this, nearly half of 9 – 10-year-old girls are dieting. Parents cannot completely overcome societal messages that glorify being thin and losing weight. But they can learn about Health at Every SizeⓇ and practice a body-positive, anti-diet lifestyle.

See Our Guide For Parenting a Young Child With An Eating Disorder