Some Clues for Parents: Does My Teenager Have an Eating Disorder?

By Elissa Gittes, MD, adolescent medicine specialist, Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC

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Eating disorders are common and complex, and can affect a teenager’s emotional and physical health. In the United States, 20 million women and 10 million men suffer from an eating disorder at some time in their life. Below are some frequently asked questions for families to review if they think that their teenager may have an eating disorder.

If you are a parent and you think your child may have an eating disorder, what can you do to help?

The elements that often predispose an individual to an eating disorder are:

  • Body dissatisfaction
  • Low self-esteem
  • Lack of coping strategies to navigate a complicated world

The specific types of eating disorders include:

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Eating disorder not otherwise specified

In all forms, the necessity for identification and treatment is the same; parents are key players in this process.

What are some clues to an adolescent with an eating disorder?

Over-concern with body weight and shape: Teens often do not realize that normal body changes for girls in puberty include fat distribution around the breasts, thighs, and hips. In boys prior to the growth spurt, there is midline fat (“chubbiness”). Parents and health care providers can help modify this common concern through education and support of these normal changes.

Avoiding family meals, skipping meals, avoiding interactions with friends or family when food is involved, reading food labels, restricting foods based on calories/fat content, and fad dieting or cleanses: Teens live in a multimedia world with constant exposure to media messages. Most messages on dieting are aimed at adults, not at adolescents, whose bodies require adequate fuel intake for the high metabolic demands. A balanced diet for teenagers, which includes all food groups and adequate fuel intake, is a healthy one.

Change in mood, emotional liability, anxiety, depression, isolation, lack of interest in prior activities: Eating disorders in their simplest form are a coping mechanism for stress. Teenagers’ lives are full with academic, social, athletic, and career pressures. Eating disorders, to a degree, allow control over one aspect of this dynamic state. Parents can help support a teenager by simplifying and prioritizing his or her activities. Encouraging some “down time” daily for self-care and emphasizing balance — not perfection — are useful. Asking for professional help through a school counselor, private therapist, or religious mentor, may help the teen develop healthier coping strategies.

An excellent resource in Allegheny County is re:solve Crisis Network for acute intervention.

Perfectionist approach to athleticism, exercising in secret, unrealistic exercise goals: Moderate exercise and the love of a sport are to be commended. However, if a parent notices an athlete regarding the sport as a chore or a rigid task with unrealistic expectations, the parent might be more suspicious of an eating disorder. Training above and beyond what is recommended by a coach may also be a clue for parents.

Some sports that are at higher risk for participants developing an eating disorder include:

  • Distance running
  • Track
  • Gymnastics
  • Cheerleading
  • Dance
  • Figure skating
  • Wrestling

Over-exercise is a form of “purging,” or ridding the body of excess calories to attain or maintain an unhealthy weight or excessively lean physique. Activity for lifelong health is recommended by the medical community. Teen athletes should be supported and encouraged. The concept of excessive exercise can be difficult to recognize by parents and providers. Asking for input from the coach about the athlete’s intensity of training and true enjoyment of the sport can be helpful. Increasing the fuel intake to balance the energy output from sports and exercise is warranted.

As with most illnesses, early detection offers a higher recovery rate and fewer lifelong consequences. A warm, non-judgmental approach might allow the young adult to disclose his or her eating disorder. Avoid blaming; there is often shame and low self-esteem in those with eating disorder diagnoses. A parent is the youth’s best advocate.

What can a parent do to start a conversation?

Sample questions that may help include:

Can we talk about the changes in your eating habits?

“It seems like some of the foods you used to enjoy, you ‘don’t like’ anymore. Since you seem concerned about your health, let’s figure out together a ‘balanced diet.’” (Look at what energy intake needs you have for your child’s stage of development, athleticism, or weight loss desires if he or she is overweight.)

Are you feeling less confident about your body?

“Everybody’s body is different, and the media portrays an unrealistic expectation for us all. Has the media, your peers, or your coach recommended you change your body shape or weight? Perhaps we can see your doctor and if you are at a high body mass index (BMI), you can start to make some changes in a safe way.”

You do not seem as positive about yourself.

“You seem sad, more quiet than usual.  May we talk? Perhaps I can help. This is a pretty stressful time for you. Sometimes it feels good to have control of something. Do you think that dieting/excessive exercise/food binges, might be a part of being more in control?  So many people feel that way, and figuring out ways to handle or lower the stress, often helps with the food issues.  Let’s tackle this together. It’s too difficult to do alone.”

Dedication to your sport and wellness is admirable.

“However, you appear to be losing weight while training by limiting your calories. Your body may start to break down muscle mass for fuel, and your athleticism may become compromised. Excessive exercise, just like inactivity, can be harmful. May we meet with your coach/instructor/trainer so that we can plan a workout regimen that will improve and maintain your athleticism? Perhaps a sports nutritionist may be helpful.”

Where can a parent find more information about eating disorders?

Many resources exist for parents to help their child with an eating disorder. Online resources include:

National Eating Disorders – www.nationaleatingdisorders.org

The Eating Disorder Foundation – www.eatingdisorderfoundation.org

Academy of Nutrition and Dietetics – www.eatright.org

Choose My Plate – www.choosemyplate.gov

For more information about the Division of Adolescent and Young Adult Medicine, call 412-692-6677 or visit www.chp.edu/adolescent.