Every single day parents grapple with whether their child is heading towards an eating disorder or just being a normal kid. Yeah, Suzi skips meals but what teen doesn’t? Their son only wants to eat protein, but don’t all boys want to gain muscle?
The reasons parents don’t seek help vary. Maybe they hope their child will outgrow body issues or they feel they haven’t done anything to promote an eating disorder.
Parents need to know that eating disorders can happen to any child and are on the rise. According to a study in the American Journal of Nutrition, between 2000-2018, global rates of eating disorders have gone from 3.4% to 7.8%. And that was before the pandemic. Research points to an increase in youth eating disorders and related hospitalizations in the past two years
The one thing that hasn’t changed: getting early help is one of the most important things parents can do. So read on to see if you child’s behavior is a red flag for an eating disorder.
The Importance of Secondary Prevention
According to Sari Shepphird Ph.D., an eating disorder specialist and author of 100 Questions & Answers About Anorexia Nervosa, eating disorders have a strong genetic connection. For example, a child whose parent suffered from an eating disorder is 12 times more likely to be diagnosed with one. And according to a 2021 report from the American Academy of Pediatrics, the mean age of onset of eating disorders is 12.5 years.
“Parents can prevent a certain amount of disordered eating,” says Laura Collins author of Eating with Your Anorexic: A Mother’s Memoir. “But some young people seem to be so deeply predisposed toward this illness that they will develop an eating disorder no matter what their environment is.”
This is where “secondary prevention” comes in. It focuses on the early identification of an eating disorder – to treat this disease before it gets out of control. Shepphird explains that when caught early, persons suffering from eating disorders have the best chance of full recovery.
So, with that in mind, here are three telltale signs that can help you catch an eating disorder early.
1. Weight loss, body preoccupation, and appearance changes
Weight loss is almost always the first sign of an impending eating disorder. The drop in weight may be hidden from others by baggy or oversized clothes.
In addition to weight loss, look for a preoccupation with body shape and weight. One example is a young girl who not only focuses on her weight but the weight of others. This weight-centric behavior is typically accompanied by a poor body image despite an average or low body weight.
As many as 25% of early onset eating disorder cases are males and their signs may be different. For example, boys tend to be more focused on muscularity instead of weight and shape. Male youths also tend to be younger at diagnosis and identify with an ethnic minority group.
Look for signs of frequent body checking in mirrors and talk of flaws in appearance. If they are at risk for bulimia, they may have more cavities or discolored teeth. And girls who menstruate may see a change or absence of their period.
“I am very thankful my parents got REALLY proactive RIGHT when I started losing weight,” said Katie, an adult women diagnosed with an eating disorder at age 15. “I can’t imagine what would have happened if they hadn’t gotten me help ASAP!”
Be aware of high risk groups
Transgender youth are at increased risk for an eating disorder diagnosis. In group of college students surveyed, 16% of transgender respondents had been diagnosed with an eating disorder, compared to 1.85% cisgender heterosexual women. Children and adolescents with health conditions that require restricting food such as diabetes, are also at higher risk.
2. Change in eating and drinking patterns
Alterations in the way your child relates to food is another red flag.
Shepphird explains that skipping meals, being anxious while eating and rituals such as dividing, weighing, and playing with food are all things to watch for (we’re not talking about picky toddler behavior here). Some might become vegetarian out of nowhere. And going straight to the bathroom after meals could also be a sign of bulimia.
Reports indicate about half of adolescents have tried dieting, a leading risk factor for eating disorders.
In a 2020 study out of the UK, adolescents were asked if they dieted or exercised to lose weight. In 2015, 44.4% said they had dieted and 60.5% had exercised to lose weight compared with 37.7% and 6.8% in 1986.
And 42.2% were currently trying to lose weight in 2015 compared with 28.6% in 2005. Although increases were bound in boys and girls, boys’ prevalence of these behaviors increased more over time.
Those who are developing a binge eating disorder may feel out of control when eating, including times where they eat much more food than would otherwise seem normal. You might find empty food wrappers in the room.
Their weight can fluctuate but in the case of bulimia and binge eating disorders, low body weight is not common.
Also be on the lookout for drinking large amounts of water or calorie-free drinks. Are they suddenly using mouthwash, mints, or gum?
“My mom once confronted me about weight loss pills, I was taking and I freaked out at her and told her they were vitamins,” said Jenny a recovering dieter. “I was young and I wish she would have been more insistent about me getting rid of them.”
Want to help your daughter develop a healthy body image? Read: 13 Things Girls with a Healthy Body Image Don’t Do
3. Excessive exercise
When Melissa was in college, she started running 7 miles almost daily, barely ate, and got down to a meager 103 pounds (she’s 5’6″). When she returned home her family was afraid to approach her even though they were concerned about her weight.
“I definitely wish my parents had been more inquisitive when they first started to notice I had lost a lot of weight,” she said. “I think they (and I) might have been able to stop the progression of my disease sooner rather than later”
Using exercise to purge calories is another warning sign. In the aforementioned study, many more adolescents use exercise as a means to control weight today (60.5%) than in previous generations (6.8%).
George Hillinger, professional fitness trainer and certified medical exercise specialist says super long cardio sessions that can go as long as an hour and a half can be problematic. The exercise behavior is excessive, he explains, and there’s an “I’ll work out at any cost” mentality.
“The biggest hurdle in what I do is teaching individuals with eating disorders that exercise is not about torture,” he said. “It’s much better if they can start at a sensible pace and find something they really enjoy doing.”
What’s a Parent to Do?
So, you’ve gathered the clues and believe that your child might have an eating disorder. What exactly should you do with this information?
“A great first step for parents is to talk to their child’s pediatrician for an accurate diagnosis and guidance for getting help,” said Shepphird. “Parents also need to learn all they can about eating disorders.”
Start by downloading this guide from the Academy of Eating Disorders. It provides education on eating disorders and the vitals and labs you’ll want your doctor to do. Be sure to ask for a copy of your child’s growth charts too.
The AAP recommends pediatricians conduct a comprehensive evaluation including both medical and psychological assessment so be sure your doctor is on top of it.
If your child’s doctor wants to do a wait and see, ask for specialist referrals in your area and let them know you don’t want to wait.
You can also get help from the National Eating Disorders Association (NEDA) by chatting at myneda.org/helpline, calling 800-931-2237 or texting 741741
Get the Support YOU Need
Laura Collins was in this very position when her daughter was diagnosed with an eating disorder at age 14. Her biggest issue was finding support from other parents going through the same thing. She found most parents hiding in shame mostly due to society’s tendency to blame parents.
“When parents spend all their time blaming themselves their energy is spent on the wrong things,” she said. “Parents need to realize it’s not their fault and that they need to be proactive with this very real and serious diagnosis.”
Because there was so little support for parents Collins decided to act. Her mission is to educate parents about eating disorders. She does this through her books and her role as F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders) Board of Directors since 2007.
Consider joining supportive private Facebook groups such as the International Eating Disorder Family Support.
The Time to Act is Now
There’s no doubt that the health and psychological consequences of eating disorders are significant. So, arm yourself with accurate information, and be on the lookout for signs and symptoms of eating disorders.
And if you start seeing some red flags, you’ll want to act. But don’t take it from me, take it from Stephanie, an adult woman who was diagnosed with an eating disorder at 18:
“I wish my mom had been more persistent and trusted her instinct. She recognized that I had a problem and confronted me about it, but in my eating disorder-fueled rage I got so upset that she backed off completely until I was really sick. If I had gotten help at that very early stage in my eating disorder, I would have spared myself a lot of agony, physical harm, and years of very expensive and grueling treatment later on.”
This post was originally published on April 22, 2010 and updated February 18, 2022
Help your daughter develop a healthy relationship with food and her body with Maryann’s book: My Body’s Superpower: The Girls’ Guide to Growing Up Healthy During Puberty