Editor’s note: This story discusses disordered eating.
Eating disorders in children and teens can be hard for parents to understand.
TODAY.com talked to experts to find out what parents and all family members should know when handling disordered eating tendencies.
Gita Chaudhuri, head of psychotherapy at The Balance rehab clinic, says one of the hardest aspects for parents is calming their own worries while remaining supportive of their kid.
“They experience a loss of control, too,” she says. “This is very challenging because parents want to protect their children.”
National Eating Disorder Awareness Week is Feb. 24-March 2. Here are some things you may not know about eating disorders, but could help family members navigate the journey.
1. Less than 6% of patients with eating disorders are medically underweight
Studies show that less than 6% of eating disorder patients are considered clinically underweight.
“If you if you believe that eating disorders only happen in smaller bodies or thin bodies, then you may be missing someone who’s struggling with an eating disorder that does not appear that way,” Dr. Doreen Marshall, chief executive officer of the National Eating Disorders Association, tells TODAY.com.
“Eating disorders do not discriminate,” she continues. “We see eating disorders in all genders, all races, all socio economic groups, all body types.”
Marshall notes that at primary care and pediatric doctors won’t typically screen for eating disorders at a routine appointment, so a child who isn’t medically underweight could be missed.
Sarah Boss, a psychologist and clinical director at The Balance rehab clinic, says parents should focus more on “sudden and big” changes in both weight and behavior.
“There are children that are really skinny and even though they’re skinny, they don’t have an eating disorder. And they might always be very skinnier than somebody on average of their age. But if parents notice a change, I think that’s the most important thing to be aware of, especially a change in behavior,” Boss says.
2. Eating disorders are a mental health condition — not solely physical
Parents often assume children and teens with eating disorders are solely trying to control their weight, when they are more likely trying to control their emotions, Chaudhuri explains.
“The eating disorder stands for, ‘This is my little space, my bubble, where I am in charge, where I control I control my life. I have control over my life,’” she says.
Rather than simply looking at the amount of food a child is consuming, Marshall says parents should look at how the child acts around eating.
“Sometimes what we see is that there’s an anxiety about food, or almost like an obsessive thinking around what I should or shouldn’t be eating, how I should or shouldn’t be exercising,” she says.
Boss says eating disorders can show up with children acting “strange” around food — avoiding sitting down for meals, becoming picky about food, strictly eating “healthy” food, becoming “very restrictive and very inflexible.”
3. The way you talk to your kids about eating and diet culture matters
When they notice a child is eating less, some parents immediately encourage them to “eat more” or comment on their appearance. (“You’re so skinny!”)
Chaudhuri says these types of remarks will “never be enough” to change a mental health condition like an eating disorder.
Instead, Chaudhuri encourages families to find an “emotional language.”
She suggests parents ask questions like, “How do you feel? What is underlying? What is an underlying emotion behind, ‘I don’t want to eat this’ or ‘I’m too fat’ or ‘I’m not good enough’?”
Boss says all family members should understand that having an eating disorder is “not a choice.”
“It’s not something anybody can stop,” she says. “It has so much to do with control.”
“Usually, there’s something so scary and threatening behind it that all this control and this behavior serves as a coping mechanism,” Boss adds.
Chaudhuri says all parents should be “normalizing the conversation” about emotions and healthy relationships with food.
As a parent of a teenager herself, Marshall says tries not to label food as “good” or “bad” and advises parents to avoid comments like “I’m saving up my calories for a big dinner” or “I’ll be good and skip dessert.”
“I think sometimes parents may not recognize that they may inadvertently be sending messages to their kids, just even by how they interact with their own bodies and how they think about their own relationships with food,” Marshall says.
4. A third of eating disorder cases are in men
Though people commonly associate young women with eating disorders, one in three eating disorder cases happen in men, studies show.
Boss explains that boys with disordered eating tendencies are often seeking a way to “soothe themselves.”
Young men, particularly those active in sports, receive similar messages as young women from society about bodily and beauty standards, which can lead to body dysmorphia, Marshall notes.
“While they may get different societal messages (than women) about how their bodies should be, they get messages, too,” Marshall says. “It may be different from the messages girls and women get, but they’re not any less impactful.”
Chaudhuri says young men typically experience orthorexic eating behaviors, where they develop an obsession with eating a rigidly healthy diet.
“In males, we often see this orthorexic behavior, eating very healthily with lots of proteins and all these kind of diets,” she says. “It can also sometimes be a hidden or covered eating disorder because society thinks for boys that’s more normal.”
With social media, Chaudhuri says young men are more exposed than ever to “constant social judgement” and comparison.
5. Anorexia isn’t the only eating disorder
When people think about eating disorders, they are often only considering anorexia nervosa, where a person limits their food intake to maintain a lower body weight. Marshall reminds that there are several more types that are more common.
Bulimia is when a person typically engages in binge eating before purging, Marshall says. She notes that binge eating in itself is an eating disorder. Orthorexia has also been more frequently diagnosed, she says.
“One of the eating disorders that we’re certainly hearing more about is something called the ARFID, which stands for avoidant restrictive food intake disorder. It’s a little bit of a different eating disorder, but it’s what has been characterized in the past as picky eating,” she says. “But this is more than that.”
ARFID “doesn’t necessarily have to be connected to body image,” according to Marshall, and can exist without any negative beliefs about appearance.
“It’s more like what I think of as aversion to some foods. It can also connect with neurodivergence and things like autism or texture sensitivities,” Marshall adds.
6. If a child needs support for an eating disorder, the parent needs support too
Though parents tend to be focused on helping their child with an eating disorder, Chaudhuri reminds of the importance of parents finding support themselves.
“If the eating disorder is already in a serious or severe stage, parents should reach out to therapists, and also self-help groups so that they find support,” Chaudhuri advises. “It’s really important because if a parent is dysregulated and scared and overly worried, a child cannot relax either.”
Chaudhuri says children are more receptive than parents often realize, and will take on a parents’ either calm and relaxed energy or anxious and overwhelmed energy.
Though important to focus on the child working through an eating disorder, Chaudhuri encourages parents to likewise “work on your own regulation.”
