For Parents

 Many kids — particularly adolescents — are concerned about how they look and can feel self-

conscious about their bodies. This can be especially true when they are going through puberty,

and undergo dramatic physical changes and face new social pressures.

Unfortunately, for a number of kids and teens, that concern can lead to an obsession that can

become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause

dramatic weight fluctuation, interfere with normal daily life, and can permanently affect their

health.

Parents can help prevent kids from developing an eating disorder by building their self-esteem

and encouraging healthy attitudes about nutrition and appearance. If you become worried that

your son or daughter might be developing an eating disorder, it’s important to step in and seek

proper professional care.

ABOUT EATING DISORDERS

Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight

and food, and eating habits that disrupt normal body function and daily activities. While more

common among girls, eating disorders can affect boys, too. Unfortunately, many kids and teens

successfully hide eating disorders from their families for months or even years.

People with anorexia have an extreme fear of weight gain and a distorted view of their body size

and shape. As a result, they strive to maintain a very low body weight. Some restrict their food

intake by dieting, fasting, or excessive exercise. People with anorexia try to eat as little as

possible, and take in as few calories as they can, frequently obsessing over food intake.

Bulimia is characterized by habitual binge eating and purging. Someone with bulimia may

undergo weight fluctuations, but rarely experiences the low weight associated with anorexia.

Both disorders can involve compulsive exercise or other forms of purging food eaten, such as by

self-induced vomiting or laxative use.

Although anorexia and bulimia are very similar, people with anorexia are usually very thin and

underweight but those with bulimia may be a normal weight or even overweight.

Binge eating disorders, food phobia, and body image disorders are also becoming increasingly

common in adolescence.

It’s important to remember that eating disorders can easily get out of hand and are difficult

habits to break. Eating disorders are serious clinical problems that require professional

treatment by doctors, therapists, and nutritionists.

CAUSES OF EATING DISORDERS

The causes of eating disorders aren’t entirely clear. However, a combination of psychological,

genetic, social, and family factors are thought to be involved.

For kids with eating disorders, there may be a difference between the way they see themselves

and how they actually look. People with anorexia or bulimia often have an intense fear of gaining

weight or being overweight and think they look bigger than they actually are. Also, certain sports

and activities (like cheerleading, gymnastics, ballet, ice skating, and wrestling) that emphasize

certain weight classes may put some kids or teens at greater risk for eating disorders.

There is also an increased incidence of other problems among kids and teens with eating

disorders, like anxiety disorders and obsessive-compulsive disorder. Sometimes, problems at

home can put kids at higher risk of problem eating behaviors.

Some research suggests that media images contribute to the rise in the incidence of eating

disorders. Most celebrities in advertising, movies, TV, and sports programs are very thin, and this

may lead girls to think that the ideal of beauty is extreme thinness. Boys, too, may try to emulate

a media ideal by drastically restricting their eating and compulsively exercising to build muscle

mass.

Concerns about eating disorders are also beginning at an alarmingly young age. Research shows

that 42% of first- to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of

being fat. In fact, most kids with eating disorders began their disordered eating between the ages

of 11 and 13.

Many kids who develop an eating disorder have low self-esteem and their focus on weight can

be an attempt to gain a sense of control at a time when their lives feel more out-of-control.

THE EFFECTS OF EATING DISORDERS

While eating disorders can result from serious mental and behavioral health conditions, as well

as trauma (for example, sexual abuse), they can lead to very serious physical health problems.

Anorexia or bulimia may cause dehydration and other medical complications like heart problems

or kidney failure. In extreme cases, eating disorders can lead to severe malnutrition and even

death.

With anorexia, the body goes into starvation mode and the lack of nutrition can affect the body

in many ways:

 a drop in blood pressure, pulse, and breathing rate

 hair loss and fingernail breakage

 loss of periods

 lanugo hair, a soft hair that can grow all over the skin

 light headedness and inability to concentrate

 anemia

 swollen joints

 brittle bones

With bulimia, frequent vomiting and lack of nutrients can cause:

 constant stomach pain

 damage to the stomach and kidneys

 tooth decay (from exposure to stomach acids)

 “chipmunk cheeks,” when the salivary glands permanently expand from throwing up so

often

 loss of periods

 loss of the mineral potassium (this can contribute to heart problems and even death)

WARNING SIGNS

It can be a challenge for parents to tell the difference between kids’ normal self-image concerns

and warning signs of an eating disorder.

While many kids and teens — girls in particular — are self-conscious, compare themselves with

others, and talk about dieting, this doesn’t necessarily mean they have eating disorders. Kids

with eating disorders show serious problems with their eating and often have physical signs.

Someone with anorexia might:

 become very thin, frail, or emaciated

 be obsessed with eating, food, and weight control

 weigh herself or himself repeatedly

 count or portion food carefully

 only eat certain foods, avoid foods like dairy, meat, wheat, etc. (of course, lots of people

who are allergic to a particular food or are vegetarians avoid certain foods)

 exercise excessively

 feel fat

 withdraw from social activities, especially meals and celebrations involving food

 be depressed, lethargic (lacking in energy), and feel cold a lot

Someone with bulimia might:

 fear weight gain

 be intensely unhappy with body size, shape, and weight

 make excuses to go to the bathroom immediately after meals

 only eat diet or low-fat foods (except during binges)

 regularly buy laxatives, diuretics, or enemas

 spend a lot of time working out or trying to work off calories

 withdraw from social activities, especially meals and celebrations involving food

IF YOU SUSPECT AN EATING DISORDER

If you suspect your son or daughter has an eating disorder, it’s important to intervene and help

your child get diagnosed and treated.

Kids with eating disorders often react defensively and angrily when confronted for the first time.

Many have trouble admitting, even to themselves, that they have a problem. Sometimes getting

a family member or friend who has been treated for an eating disorder can help encourage

someone to get help. A fear of being fat or overweight is a core problem for anyone with an

eating disorder. So it’s understandable that kids with eating disorders don’t want to go to a clinic

and “get fat.”

Trying to help when someone doesn’t think he or she needs it can be hard. Still, getting the

professional assistance needed, even if your child resists, is essential. Enlist help from friends and

family that your son or daughter trusts and loves — people known to have your child’s best

interests at heart.

Your child may be more receptive to a conversation if you focus on your own concerns and use

“I” statements rather than “you” statements. For example, steer clear of statements like “you

have an eating disorder” or “you’re too thin,” which may only prompt anger and denial. Instead,

try “I’m worried that you have lost so much weight so quickly.” Cite specific things your child has

said or done that have made you worry, and explain that you will be scheduling a doctor’s

appointment to put your own mind at ease.

If you still encounter resistance, talk with your doctor or a mental health care professional about

other approaches.

The other day I heard my 13-year-old daughter complain, “I’m fat.” She’s started to stay away

from family meals and says she’s not hungry. I’m upset that she’s already worried about her

weight and that she may be developing an eating disorder. How do I know if there’s a problem

and what can I do to help her if there is?

– Dana

It’s common for teens to be concerned about how they look and to feel self-conscious about

their weight. During puberty, kids’ bodies change dramatically and they face mounting social

pressures, like dating, making friends, and fitting in.

But when these concerns become obsessions or begin to involve abnormal behaviors or negative

thoughts about body image, weight, and food, eating disorderscan occur. Someone who starts to

do things that are emotionally or physically dangerous in order to lose weight may have an

eating problem.

Other signs of an eating disorder include becoming very thin, having a fear of weight gain,

playing with or moving food around on the plate instead of eating it, exercising compulsively,

loss of menstrual periods, or constantly talking about weight and food. Some people with eating

disorders binge eat, then induce vomiting, use laxatives, or use diuretics.

If you’re concerned that your daughter may have an eating disorder, it’s important to get her the

help she may need right away. Let her know that you’re worried because of the things that you

have noticed. Disordered eating can be very dangerous and can lead to a variety of health

problems. Have your daughter talk to a counselor, doctor, or a mental health professional.

TREATING EATING DISORDERS

Treatment focuses on helping kids cope with their disordered eating behaviors and establish new

patterns of thinking about and approaching food. This can involve medical supervision,

nutritional counseling, and therapy. The professionals will address a child’s perception about

body size, shape, eating, and food.

Kids who are severely malnourished may require hospitalization and ongoing care after their

medical condition stabilizes.

Generally, the earlier the intervention (ideally, before malnutrition or a continual binge-purge

cycle starts), the shorter the treatment required.

PREVENTING EATING DISORDERS

You can play a powerful role in your child’s development of healthy attitudes about food and

nutrition. Your own body image can influence your kids. If you constantly say “I’m fat,” complain

about exercise, and practice “yo-yo” dieting, your kids might feel that a distorted body image is

normal and acceptable.

At a time of great societal concern about obesity, it can be tricky for parents to talk with their

kids about their eating habits. It’s best to emphasize health, rather than weight. Make sure your

kids know you love them for who they are, not how they look.

It’s OK to appreciate attractiveness in celebrities — if your kids (and you!) feel fine about how

they look, it won’t prompt them to try to change to be like someone else. Getting the message

that they’re great as they are and that their bodies are healthy and strong is a wonderful gift that

parents can give their kids.

Try to avoid power struggles regarding food — if your teen wants to “go vegetarian,” be

supportive even if you’re an avid meat-eater. Teens frequently go through trendy eating periods,

so try to set good limits, encourage healthy eating, and avoid fighting over food issues. Kids can

catch on pretty quickly if their parents panic over one skipped meal. Try to gain perspective and

talk to your kids about what’s going on if they don’t want to eat with the family.

Finally, take an active role in creating a healthy lifestyle for your family. Involve your kids in the

preparation of healthy, nutritious meals. Let them know that it’s OK to eat when hungry and

refuse food when they’re not. Also, make exercise a fun, rewarding, and regular family activity.

Developing your own healthy attitudes about food and exercise will set an excellent example for

your kids.