The isolation and stress of more than a year of pandemic living have taken a toll on the mental health of tweens and teens. Health centers and medical professionals have reported that many more kids are coming in for mental health issues, including eating disorders. Some treatment facilities have months’ long wait times, and providers are overstretched trying to meet the demand for their care.
“A lot of kids have said that the isolation of the pandemic made room for their eating disorders to develop,” says Christina Wierenga, Ph.D., professor of psychiatry and supervising psychologist at the Eating Disorders Center for Treatment and Research at the University of California at San Diego. Other contributors could simply be increased stress or spending more time on social media where — girls in particular — are bombarded with messages about what their bodies should look like and how to get there.
Whatever the particular causes right now, it’s important for parents and caregivers to have the information they need to know when their child is struggling and how to get them good help.
What causes eating disorders?
Increasingly, researchers are finding that — rather than there being one specific cause of eating disorders—such as having poor body image or a need for control — there are many factors that can come together in a perfect storm.
“What we do know is that there seems to be a strong biological component,” says Wierenga. “Studies have identified that up to 80% of the risk of developing an eating disorder has to do with heredity.” That means that children with a family history of eating disorders are at greater risk, but there are also inherited personality traits that can make someone more vulnerable to an eating disorder, such as perfectionism, high anxiety, and high achievement.
Other factors include environmental influences such as stress, food insecurity, being bullied or made fun of for your weight or shape, and social media messaging about what bodies should look like. Participating in organized sports that focus on thinness or eating a certain way to maximize performance can also make kids vulnerable.
“For kids, one of the biggest triggers for an eating disorder is an attempt to eat healthier,” says Oona Hanson, a family mentor with Equip, a treatment program that helps families provide eating disorder treatment at home. When kids lose weight — for any reason (including side effects of medication, increased sports intensity, illness, or surgery) — they often receive praise from friends and family, potentially introducing or reinforcing restricting. Reaching a significant calorie deficit can also trigger a reaction in the brain that drives further restriction, bingeing, purging, or a combination of all three.
Myths that keep us from realizing a child needs help
Eating disorders don’t have a look. They affect boys and girls, people of all socioeconomic statuses, body types, and races.
The number one myth is that eating disorders only happen to thin, white, high-achieving teenage girls. “Eating disorders don’t have a look,” says Hanson. “They affect boys and girls, people of all socioeconomic statuses, body types, and races.”
In fact, children labeled on the BMI chart as “overweight” or “obese” can be suffering from an eating disorder and be just as sick as someone who is emaciated, says Virginia Sole-Smith, author of The Eating Instinct. “Often they are even sicker by the time they reach treatment because their eating disorder has been ignored for much longer.” Similarly, eating disorders in boys can go unnoticed for longer because there is more acceptance of them changing their diets to “maximize performance” in sports.
It’s also important for parents of LGBTQ kids to know that eating disorder rates are much higher in those communities.
“People say my kid has a happy life, is well cared for, has no traumas, they could never be at risk,” says Hanson, “but an eating disorder can be happening in their house, and they might not notice it till they know what to look for.”
How do I know if my child has an eating disorder?
One important sign that a child is struggling with — or is vulnerable to developing — an eating disorder is that they make a significant change in how they eat. On the face of it, the change could seem “healthy,” such as announcing they are doing a sugar detox, limiting carbs, or becoming vegetarian. Still, it can represent a disordered relationship with food or put them at risk of becoming undernourished, triggering an eating disorder.
Other signs to watch out for:
- Changes in language around food, like categorizing foods as “good” and “bad” and avoiding the latter.
- Compulsive exercise that your child may not even enjoy but is rigid about doing consistently, such as exercising even in bad weather or when injured.
- A new preoccupation with body size. Phrases like. “’ I’m the biggest one in my class’ or ‘the other girls are smaller than me,’ are not necessarily warning signs of eating disorders,” says Jodi Rubin, LCSW, a therapist who specializes in eating disorders in New York City, “but they are things to pay attention to that could contribute to a moment when an eating disorder is triggered.”
- Mood changes, including isolating themselves or being anxious or depressed.
- Girls having their periods stop or not beginning when expected.
- Weight loss. No matter a child’s body type or size, “weight loss in kids should be a cause of concern, not celebration,” says Hanson. “They are supposed to be growing.”
- Vomiting or spending time in the bathroom after meals.
- Food packages in their room or other evidence of secretive eating.
When to take action
If your child is showing any of the signs above, it’s worth taking a closer look and talking to them about it. “It’s better to act too urgently and blow up something that isn’t a big deal than neglect to identify something that ends up being a big deal,” advises Wierenga.
How to talk to your kid if you’re worried
“You don’t want to go in with guns blazing, telling them ‘I think you have an eating disorder,’” says Sole-Smith. “That will just shut your kids down. The big mistake parents make is making it about the food, saying things like, ‘you are not eating enough.’ The reality is it’s not only about the food. Your kid is struggling with other factors that are making them behave this way with food, so you want to ask them, ‘how are you doing emotionally?’ ‘what do you need from us?’ rather than focusing on the behavior.”
And when they answer? “Just genuinely be curious and listen,” says Rubin.
Where to look for help
Your pediatrician can screen your child for symptoms of depression or anxiety and check where they are in their growth chart. “They should be growing along their curve,” says Hanson. “If a child has fallen off their growth curve— regardless of where they are on the BMI (body mass index), that is worth an evaluation from an eating disorder specialist.”
You can find an eating disorder specialist — a psychotherapist, psychologist, or eating disorder registered dietician— through your pediatrician or the National Eating Disorders Association (NEDA), which also offers a crisis hotline and resources for families. Telehealth and web-based therapy have made it much easier to access a specialist, even if there isn’t one in your area.
“I believe in throwing the kitchen sink at it and doing everything possible to catch and nip this in the bud before it grows,” says Wierenga. She recommends “conversations with the pediatrician and parents educating themselves and joining good parent support groups.” You can find them at NEDA and F.E.A.S.T.
What treatment for eating disorders looks like
“Step one is feeding a child back to health,” says Hanson. “If the body and brain are malnourished, that person cannot get well. They will continue to have obsessive thoughts and behaviors driven by the eating disorder.”
That can be accomplished at home in a highly effective (and often preferred) approach called Family-Based Treatment where parents monitor their child’s food intake and work to restore them to health through a three-stage process, or in a number of settings depending on the severity of a child’s eating disorder.
Other options (in order of intensity):
- Outpatient treatment involves individual therapy, group therapy, nutrition therapy, and working with a doctor, all while living at home.
- Intensive Outpatient Therapy offers the same kinds of supports but in a treatment center for a few hours, a few days a week.
- Partial Hospitalization Programs are similar to IOP, but for longer hours (typically Monday through Friday 9 to 5). Most of the services the patient receives — such as therapy — will happen in the center.
- Residential programs are in-house treatment programs in which a person stays at the center for a period of time until they are stable enough to step down to the next level of care (such as PHP or IOP).
- Hospitalization is reserved for patients who need intensive medical intervention before they can begin to work on their eating disorder in one of these other settings.
Thinking that your child may have an eating disorder is scary but not as scary as letting it get worse, which is why it’s better to lean in and support your child than take a wait-and-see approach. “So many parents think this is just a phase, this is no big deal. My bias is always toward it’s probably worse than you think it is,” says Hanson. “If something seems off, listen to your gut.”
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