Eating disorders are a significant concern, particularly during adolescence. This article explores the vulnerabilities of this developmental stage, preventative measures parents can take, and available resources for those concerned about an adolescent in their life.
The Rise of Eating Disorders During Adolescence
Adolescence, defined by the World Health Organization (WHO) as the period between 10 and 19 years, is a critical time for the onset of eating disorders. This typically occurs between the ages of 12 and 25. A recent systematic review and meta-analysis revealed that the global overall proportion of children and adolescents with disordered eating from 1999-2022 was 22.36 percent. Disordered eating appears to be more common in girls (30%) than boys (17%), and the numbers are increasing among older adolescents and adolescents with higher BMIs.
Many individuals develop eating disorders during adolescence. As Kate Willsky, Equip’s Senior Manager of Content, recalls, her eating disorder began at age 11, between 5th and 6th grade when she became increasingly aware of her body size, comparing it to images in media like Seventeen Magazine. She started reading nutrition labels and doing abdominal crunches. Her doctor noted her weight loss, which was praised initially, accelerating her eating disorder. By the autumn of 6th grade, she was diagnosed with anorexia and admitted to inpatient treatment by December.
Eating disorders are ranked as the third most common chronic illness in adolescent females, with an incidence of up to five percent, although they can affect anyone of any gender, sexual orientation, age, race, and socioeconomic status.
Recognizing the Signs of Eating Disorders
Eating disorders manifest in various ways, often concealed, making them difficult to detect. Parents and guardians should be vigilant in observing changes that may indicate a problem.
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Common warning signs, according to Equip psychiatrist Dr. Barbara Kessel, DO, CEDS, include:
- Changes in diet: Skipping meals, eating alone, avoiding food-related activities, cutting out favorite foods or entire food groups, fixating on macronutrients, or dieting.
- Changes in exercise habits: Exercising beyond scheduled sports activities or sacrificing sleep or other activities to work out.
- Concerns over body image: Preoccupation with appearance, body checking, or wearing baggy clothes to hide their body.
- Changes in other food- or body-related behavior: Hiding or sneaking food, tracking calories, or frequent weighing.
- Mood changes: Withdrawal, sadness, or irritability. Adolescents with eating disorders may also become angrier, more irritable, or more childlike, among other potential mood changes.
Kessel notes that detecting eating disorders in adolescents can be challenging because of the rapid physical changes during puberty, which are commonly associated with mood changes or irritability.
Risk Factors During Adolescence
"Adolescence is a time that is fraught with changes,” Kessel says. “Pubertal changes can be scary and difficult for some, and this time often comes with changes in peer groups and increased complexity of relationships. Not all kids develop at the same time or same rate, making comparisons to peers a potential challenge. Girls who develop earlier or are on higher percentiles for height and weight are known to be at higher risk for developing an eating disorder.”
In addition to puberty, dieting is a significant risk factor at any age. A recent study indicated that dieting in the past 12 months was associated with greater eating disorder psychopathology in most groups. Data from the National Health and Nutrition Examination Survey shows that 37.6 percent of adolescents aged 16 to 19 tried to lose weight in the past year, with weight loss attempts higher among adolescent girls (45.2%) compared with adolescent boys (30.1%).
Other risk factors include:
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- Social media use: "Misuse of social media platforms" in adolescents is likely a significant contributing factor to the rise of eating disorders.
- Body-focused sports: Sports and activities that encourage weight loss or emphasize thinness like wrestling or ballet may put adolescents at a higher risk for eating disorders.
- Family history: Studies have found increased rates of eating disorders in relatives of those with anorexia and bulimia, and a first-degree relative of someone with an eating disorder is up to 12 times more likely to develop one than a person without a relative who has an eating disorder.
Willsky recalls that the social upheaval of transitioning to middle school exacerbated her issues. She found comfort in the simplicity and clarity of her eating disorder's rules amidst the overwhelming cliques and popularity politics. She also felt pressure from dating and wanting to be attractive, internalizing the message that thinness was necessary to meet beauty ideals.
Prevention Strategies for Parents
While there is no single cause or guaranteed prevention strategy for eating disorders, certain parenting strategies and everyday habits can foster a healthier mindset around food, exercise, and body image.
Kessel emphasizes that parents can't control everything in their adolescent's life and should allow for increasing independence and autonomy. However, some strategies can decrease the risk of developing an eating disorder.
- Demonstrate healthy attitudes: Willsky advises parents to watch their language and audit their own internal beliefs. She remembers things her parents said, with no ill-intent, that fueled her eating disorder, such as the idea that you ‘earn’ or ‘deserve’ food through physical activity.
Kessel agrees that prevention starts at home by promoting a body-positive environment and modeling an ‘all foods fit’ attitude to nutrition. This means not moralizing foods or bodies as ‘good’ or ‘bad,’ and modeling that varied diets and body types are all part of living life. Parents may need to work on their own relationships with food, exercise, and their bodies, and consider seeking professional help if they struggle with this.
- Eat together as often as possible: Kessel says that having regular family meals is a great way for parents to keep a pulse on how their kids are relating with food and provides an opportunity to improve connection within the family.
- Keep close tabs on social media use: Kessel recommends keeping kids off of social media altogether for as long as possible, as it has been shown to increase the risk of eating disorders, disordered eating, depression, and anxiety. If parents allow social media, they should limit the time allowed on the apps and discuss the dangers involved, teaching kids how to spot ads and accounts that might be profiting off of their insecurities and to think about them critically. Parents should require they have access to their adolescent’s accounts and check in on them regularly.
- Don’t hesitate to seek support: Willsky advises parents to get help immediately if they're concerned, as the longer these illnesses take hold, the more entrenched they become. Even if a child doesn't have an eating disorder, it's better to be safe than sorry.
- Persevere through pushback: Willsky says that parents might be scared to make their child mad, fearing they will retreat and close them out. But the reality is, if a child has an eating disorder, this is inevitable. The eating disorder will get mad, and get loud, and the child needs their parents to fight back, because even though it seems like they're fighting with their child, they're really battling the illness that has them in a chokehold. They will not stop disordered behaviors of their own accord; they need their parents to help them. And though they may kick and scream and say horrible things in the moment, they will be thankful in the end.
Treatment Options and What to Do If You’re Worried
Family-based treatment (FBT) is considered the gold standard of care for treating eating disorders in young people. Kessel says that FBT is a manualized treatment that requires specialty training, and parents should look for providers or programs that offer treatment based on this model. It requires heavy involvement from parents early on in the treatment, with parents gradually guiding their adolescent back to age-appropriate independence over time.
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When choosing the type of treatment that will work best for an adolescent, Kessel advises parents to consider the severity of their child’s illness as well as their own ability to supervise the early stages of recovery and participate in treatment. It is best to keep an adolescent in the least restrictive environment where they will have an opportunity to be successful, allowing them the least interruption to school, activities, and relationships as possible for the shortest amount of time. Options should be discussed with your child’s PCP or mental health providers.
If you’re concerned that your child might have an eating disorder, Kessel says to listen to your gut and bring up your concerns to both your child and their PCP. Don’t wait. The earlier an eating disorder is detected and treated, the higher likelihood that your child will be able to achieve a long and meaningful recovery.
Parents can have a profound impact and influence on their child’s recovery, but it’s also critical to understand that parents are not the cause of their child’s eating disorder. Kessel says that when an adolescent develops an eating disorder, it’s no one’s fault, and they are not a choice. Eating disorders have complex causes including genetic risk factors, developmental risk factors, psychological risk factors, and sociocultural risk factors. Once an eating disorder has taken hold, there are biological and psychosocial factors that contribute to maintaining them. Adolescents need consistent and loving support from their parents to make recovery possible.
Willsky agrees, reiterating that eating disorders are not the fault of parents, but parents do play a pivotal role in helping their child recover.
The Impact of Binge Eating on Weight Loss
Binge eating is common among overweight and obese individuals seeking weight loss treatment and there is some indication it is associated with poor treatment compliance. Some have suggested that binge eating needs to be addressed prior to weight loss, yet empirical support for this recommendation is lacking. Binge eating is prevalent in overweight and obese individuals with type 2 diabetes, with rates of binge eating disorder (BED) in this population ranging from 1.4% to 9%. A recent study examining 845 overweight and obese individuals with type 2 diabetes seeking entry into weight loss treatment found that 5.6% of individuals reported 8 or more objective binge episodes in the prior month and 1.4% met full diagnostic criteria for BED. Despite the frequency of binge eating in overweight and obese individuals with type 2 diabetes, little is known about how this behavior affects weight loss outcomes in this high-risk population.
In a study examining binge eating in overweight and obese individuals with type 2 diabetes, approximately 1 in 10 reported having 1 or more episodes of binge eating in the 6 months prior to study entry. These individuals were younger and more likely to be female, Caucasian, and college educated than their non-binge eating counterparts; demographic differences that are consistent with prior reports of binge eating in individuals with type 2 diabetes. As reported by others, individuals reporting binge eating at study entry had more difficulties with weight control and were heavier and had more extensive weight loss histories. Individuals reporting binge eating in this sample reported higher levels of depressive symptomatology, again consistent with the existing binge eating literature; however, depression levels in this sample were quite low even among individuals reporting binge eating. Binge drinking was also infrequent in this sample. Individuals reporting binge eating at study entry had worse physical health.
The study found that greater weight losses were observed in participants who stopped binge eating at 1-year (5.3±.4 kg) and in those who reported no binge eating at either time point (4.8±.1 kg) than in those who continued to binge eat (3.1±.6 kg) and those who began binge eating at 1-year (3.0±.6 kg) (p=.0003).