Eating disorders are extremely common among teenagers. For parents and guardians, who are often the first line of defense, the right amount of support and understanding at the right time can make all the difference. 
While dieting continues to be discussed and viewed as a cultural norm, eating disorders have reached epidemic proportions in our nation. Paying attention to the signs and signals from your teen is imperative to their health and well-being. The National Eating Disorders Association (NEDA) notes the following statistics:
• “In a large study of 14- and 15-year-olds, dieting was the most important predictor of a developing eating disorder. Those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.”
• “62.3% of teenage girls and 28.8% of teenage boys report trying to lose weight. 58.6% of girls and 28.2% of boys are actively dieting. 68.4% of girls and 51% of boys exercise with the goal of losing weight or to avoid gaining weight.”
• “Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.”
• “LGBTQ+ people face unique challenges that may put them at greater risk of developing an eating disorder. Research shows that, beginning as early as 12, gay, lesbian, and bisexual teens may be at higher risk of binge-eating and purging than heterosexual peers.”
• Transgender teens are at increased risk of eating disorders due, in part, to high levels of gender dysphoria and body dissatisfaction. According to one study, approximately 15% of transgender youths had elevated scores on the Eating Disorder Examination Questionnaire (EDE-Q) (Avila et al., 2019).
What Are Eating Disorders
An eating disorder is a psychiatric condition in which there is a persistent disturbance of eating or eating related behaviors that often results in medical, psychological, and social impairment. The most common eating disorders are binge-eating disorder, bulimia, anorexia, and other specified feeding or eating disorder (OSFED).
People with Binge-eating disorder engage in binge eating episodes. They eat large amounts of food in a discrete period of time, often feeling out of control and past feeling full. Those struggling with binge-eating disorder often experience a great deal of shame with their behaviors and unlike bulimia, they do not compensate for the food intake.
Individuals with Bulimia Nervosa engage in cycles of binge eating and purging behaviors to compensate for binge eating episodes. The purging associated with bulimia may take many forms including self-induced vomiting, excessive use of laxatives or diuretics, or compulsive exercising.
Those who struggle with Anorexia Nervosa or Atypical Anorexia Nervosa purposefully restrict their intake, which leads to significant weight loss and/or a significantly low body weight in the context of age, developmental trajectory, and physical health. These individuals have an intense fear of gaining weight and high levels of body dissatisfaction regardless of weight, shape, or body size. Those with AN binge/purge type also engage in binge eating episodes and/or purging.
Finally, Other Specified Feeding or Eating Disorder (OSFED) is a diagnosis given to those who do not meet the strict diagnostic criteria for AN, BN, or BED, but report behaviors and symptoms severe enough to cause impairment across various domains.
6 Tips to Help You Better Understand Your Teen
As a parent or caregiver, your support is imperative. Below are a few tips you can use to assist your teen as they move through their journey of adolescence and aid in preventing symptoms of disordered eating.
1. Repeat After Me: It’s Not Just A Phase
As much as we may believe our teens will grow out of a certain stage, it is not helpful for them to hear this too often.
Parts of this may be true, but emphasizing it dismisses and invalidates their current experience.
Dieting, disordered eating and eating disorder symptoms such as restricting, bingeing, purging, or over-exercising should be addressed immediately with your teen given the potentially harmful mental and physical consequences of these behaviors.
Seeking professional support from a therapist or an anti-diet dietician could be helpful as your teen begins to navigate their relationship with food and their bodies. Dieting is one of the most common triggers for the development of an eating disorder, so any signs of restricting should be taken seriously.
2. Know the Warning Signs
The warning signs of an eating disorder can be easily missed in a culture obsessed with health, fitness, and weight loss. Eating disorders are serious, potentially fatal disorders, and can affect your teen at any weight, shape or size. It’s important that parents recognize the early warning signs and symptoms so that their teen can get the support they need as soon as possible. Some potential signs include:
- Fluctuations in weight
- Obsessing over food/calories, body size and shape, and exercise
- Developing and adhering rigidly to specific food or exercise rules, routines and rituals
- Disappearing after meals
- Wearing baggy clothes to hide their body
- Eliminating foods or decreasing food variety
- Hiding or hoarding food
- Eating in secret/isolation
- Eating more/less than usual, or at a slower or faster pace
- Engaging in a lot of baking or cooking for others
- Isolating; withdrawing from friends and activities
- Menstrual irregularities
- Other physiological signs including cold hands/swollen feet; dehydration; dry skin/hair; discoloration of teeth or cavities; impaired immune function; swelling around salivary glands; difficulty concentrating; fainting; GI complaints; and sleep disturbances
3. Acknowledge the Pressures of Social Media
Oh, the joys of social media. This ubiquitous tool has helped us stay connected to our past, our present, our future, celebrities, influencers, people from across the world, and so many others. Social media can be cool! But it can also be a hard place to navigate as a teenager—it promotes comparison and allows for friends, acquaintances, family members and strangers to like and comment on our appearance and our lives.
Challenge your teen to limit their usage of social media, use safety features and/or apply settings that will minimize exposure to triggering content. Could they feel out of the loop when others are talking about the latest Tiktok trend? Yes. Is that OK? Also, yes! It is not your responsibility or that of your teen’s to be the expert on all things circulating online.
Another option is to encourage your teen to follow accounts that are diverse in body size and shape and unfollow accounts that have negative impact on self-esteem. Many qualified therapists and dietitians provide free educational and inspirational content, as well. Exposure to different perspectives and images can help your teen challenge many of the toxic messages and images rooted in diet culture and weight stigma.
4. Notice Their Emotions and Behaviors; They Want You To
Did you know that your teen wants you to notice them? It might feel odd, especially when they dart to their room or shrug their shoulders when we try and talk to them. But the truth is that our teens feel safe and secure when they know they have caring supporters at home.
Yes, eyes may be rolled, and questions may loom in the air before finally being answered, but don’t stop asking. Describe what you’re noticing and try to take a guess at what they’re feeling. For example, “I see your eyes welling up and you look so sad. Is that what you’re feeling?” These observations can help your teen feel safe expressing their emotions to you, as well as help them improve their own emotional awareness.
I previously worked with a 16-year-old who told me that she did not know how to communicate with her parents. She started restricting breakfast so she could get to school earlier to finish her work. When no one asked her why she wasn’t eating her favorite Nutella waffles anymore, she felt a bit disconnected. Enter the eating disorder (ED). ED began telling her that her parents didn’t love her and that she needed to do more things to get noticed. So, she threw away her lunch every day, chose schoolwork over dinner and started dropping weight. Soon, she started calling out of work, cancelling plans with her friends, isolating in her room. One day, mom checked-in after her daughter received a failing grade on her report card. The tears flooded her eyes and she finally opened up to mom about how scared she was. She reported to me in session that she had wished this conversation could have happened sooner.
Trust me, they want you to notice, and they want you to ask.
5. Get Involved – You Are Their Parent, Not Their Friend
It is OK to follow your teen on social media. It is OK to talk with other parents before your child spends the night somewhere. It is OK to have conversations about what is helpful and unhelpful for their bodies especially when the cultural pressures of dieting or looking a certain way begin to encroach upon them.
By the way, let’s steer them away from dieting and more in the direction of eating intuitively, honoring their body’s cues, as well as recognizing their body’s amazing capabilities.
It is OK to encourage your teen to read more, play more and rest more. Our teens are not little adults; they are adolescents with brains that are not at all fully formed. In the mental health field, we know that the best success comes when we have support. So, take your teen out for solo dates. Give them freedom while also having a healthy understanding of where they are and who they are with. Help them see and value the wonderful qualities within them that have nothing to do with their appearance.
Be intentional with your words and actions and continue to work on your own relationship with food, exercise, body image, and mental health—they are watching and learning from you.
6. Honor Their Bravery and Honesty
If your teen must tell you something important, scary, intense, or nerve-wracking for them, chances are they have thought about how they are going to tell you over and over again.
When they do, listen. Actively listen. Reflect only what you hear them say – not how you would handle the situation. Try to see the situation through their eyes and validate their emotions. Then, acknowledge the strength it may have taken for them to tell you.
Remind them that you love them, and together work out a solution. Your teen is exceptionally brave! Navigating the pressures of adolescence is quite the feat these days! Champion them when you can. They need to hear how proud of them you are.
Treatment Options
Levels of care can range from weekly appointments with an outpatient team, an intensive outpatient program (IOP), a partial hospitalization program (PHP), a residential program (RES), or in severe cases, an inpatient hospitalization setting (IP).
The Renfrew Center is unique among eating disorder treatment centers in offering not only inpatient programs, but a full continuum of care. This comprehensive range of services is tailored to each patient, with input from their referring therapist, to develop treatment plans and goals based on the specific needs identified.
Conclusion
Eating disorders are unfortunately all-too common among teenagers. This is partly because the pathways which lead to disordered eating are often far too easy for teens to fall into. As parents and guardians, we must have the tools to recognize these paths so we can offer guidance when it’s needed most.
