When Food Becomes the Enemy: The Battle Against Eating Disorders

When parents talk to their kids about puberty, they focus on the changes they will see — hair under their arms and in private areas. For boys, you might mention changes in their voices. For girls, you explain menstruation. But, parents rarely focus on puberty as a reflection of body image.

Recent studies as reported by the National Eating Disorder Association (NEDA) have shown that about 50% of preadolescent girls and 30% of preadolescent boys dislike their body. This is a concerning statistic since negative body image is a contributing factor to youth developing eating disorders.

It’s important to understand the signs and symptoms of eating disorders to catch them early. “Eating disorders can be treated and there is a lot of hope for children and adolescents,” says Dr. Carrie Poline, a double board-certified practitioner in child and adolescent and adult psychiatry, and former medical director of The Atlanta Center for Eating Disorders.

Initial Indicators

Changes in eating patterns can signal that something is wrong. These shifts can be sudden or happen slowly and will vary based on the type of disorder your child may be experiencing. “You have to be aware of your kid’s habits,” says Jill Lewis, a clinical psychotherapist and certified group therapist based in Sandy Springs. “We don’t always want to jump to conclusions and it’s not always bad, but you do need to be attuned to changes.” Restrictive eating disorders, such as anorexia nervosa, involve things like the removal of food and skipping meals or social events involving food. If your child is eliminating entire food groups, be curious and ask why.

“Another sign is an intense focus on body image,” says Poline. “Talking about it a lot, asking for reassurance with questions like, Am I fat?” A fixation on movement is another common indication. “Needing to move a certain amount of steps a day all of a sudden can be a clue,” says Poline.

When it comes to bulimia or binge eating, the signs include frequent trips to the bathroom following meals, money missing or being charged for binge episodes and secret eating. “Food wrappers under the bed or in drawers and lying about why they are there is common in situations of a binge/purge disorder,” says Lewis.

Social isolation and general withdrawal is a sign across the board. “It can look a lot like depression,” says Poline. “The key is you want your child to still be able to nourish themselves and maintain developmentally appropriate growth and weight patterns.” If the habits you notice are negatively impacting that, things can snowball quickly without intervention.

Common Contributors

There is not a single cause or trigger for developing an eating disorder. “Usually, eating disorders are the product of a perfect storm,” says Poline.

Family dynamics can play a role. “How does the family talk about food in their house?,” says Lewis. “If one parent is very permissive and the other is very strict, especially around food, this can be confusing for kids.”

Genetic pre-disposition is another factor. “Often a family member has experienced an eating disorder in the past,” says Poline. Personality vulnerabilities are related to this as well. “Those who are more likely to become anorexic are often high-functioning type A personalities with perfectionist tendencies, while those with bulimia tend to have risk-taking or impulsive characteristics.”

An event, a transition or a trauma is often a trigger for developing an eating disorder. “This can be something we, as adults, would think of as a trauma — someone passing away or a divorce,” says Lewis. “But, it can also be something like making a C on a test.”

Any combination of these factors can set off behaviors that lead to an eating disorder. Add to that societal standards of beauty and you have a perfect storm. “Social media doesn’t cause eating disorders, but the reinforcement of certain body types or restrictive diets being normalized is a stressor and can worsen the mindset of someone struggling to have a healthy relationship with food and body image,” says Poline.

Time to Talk

Before you mention concerns to your child, do your homework. The type of disorder your child is suffering from can impact the way you should approach the subject.

“Parents need to look inward at their own food intake and relationships with their own bodies,” says Lewis. “Many times parents create the issue with weight.”

Some key tips for the conversation are:

• Avoid judgment and the subject of food
• Don’t talk about body size
• Show compassion and love
• Ask open-ended questions
• Offer help
• Validate their feelings
• Be non-accusatory

Approach the conversation with curiosity. Lewis recommends starting with something simple like — How are things going in school? or I noticed you’ve been withdrawn. What’s going on? “Talk about the kid’s experience,” she says. “Even if you feel uncomfortable or anxious, stay open and show support, which will help your child open up.”

You can also help your child understand that all bodies are different and special. Offer going on family walks or seeing a nutritionist. Ask your child what they think can help her love her body more. Discuss how your child can best nourish his body for healthy growth and development.

“The cardinal rule about approaching eating disorders is to understand that most people with an eating disorder don’t want to share or talk about it,” says Poline. “They want to stay unwell. And, there is a lot of shame, so you want to avoid placing blame.”

Seek Solutions

Early intervention is integral to treating an eating disorder. “The sooner we interrupt an eating disorder, the higher level of success the child has,” says Lewis.

Eating disorders are tricky and usually require professional intervention. “Find a therapist or registered dietician with a background in eating disorders,” says Poline. She also recommends taking your child to the pediatrician with any early concerns. They will be able to determine if the child is medically unstable, has fallen off of her growth curve and help make recommendations for determining care.

Treatment is key to limiting the negative social and physical effects of eating disorders. Because so many people with eating disorders become withdrawn, there can be stunted emotional and social development. “If the eating disorder begins at 10, that’s where the brain development stopped,” says Lewis.

Self-harm is also a concern. “This is especially common in cases of binge/purge eating disorders,” says Poline.

Long-term, eating disorders can cause serious physical health concerns such as low heart rate, low electrolytes, loss of menses and reduced bone density. “In the most severe cases, eating disorders can be lethal,” says Poline.

It’s not easy. “Many children will hate you because you are threatening their disorder,” says Lewis. “It’s hard, but take action.”

Though treatment is a long road and requires work at home, it can be successful. “Understanding the eating disorder is such a big part of recovery,” says Poline. “Parents need to know they didn’t cause the eating disorder, and they shouldn’t feel guilty about helping their child. It often doesn’t feel good, but it is the right thing to do.”

Types of Eating Disorders

There are 11 types of eating disorders. These conditions impact both genders and people of all ages. The more commonly known eating disorders include:

• Anorexia Nervosa
• Binge Eating Disorder
• Bulimia Nervosa
• Avoidant/Restrictive Food Intake Disorder (ARFID) is a newly recognized eating disorder, that while restrictive, isn’t related to losing weight or body image. It typically develops in younger children and is centered around sensitivity to the way a food looks, smells and/or tastes. This disorder is common in those on the autism spectrum. Source: NEDA

Disordered Eating vs. Eating Disorders

Disordered eating and eating disorders are related as they both pertain to problematic eating patterns, but they are different. Disordered eating refers to a spectrum of problematic eating behaviors and distorted attitudes towards food, weight, shape and appearance. Eating disorders are complex mental illnesses that are characterized by persistent disturbances in eating behaviors and impairment in psychological functioning. Disordered eating behaviors — skipping meals, using laxatives, excessive exercising and restricting food groups — can mimic those of eating disorders, but are less severe, frequent and do not include psychological criteria for a diagnosable eating disorder. Source: NEDA

– Tali Benjamin