Adolescence and Eating Disorders

By: Debra O'Donnell, LMFT, LCSW

“She doesn’t know that I know, but my teenage daughter binges and vomits every night. Is this a phase, or is it an eating disorder.  Should I talk to her? Should I be worried?” The answer is yes. 

You should be worried.  Food consumption of American adolescents is characterized by a high intake of fat, sugar and salt, and the near absence of fiber, fruit, vegetables, and healthful fats.  Their physical activity has also markedly declined. Also of great concern is the adolescent embrace (like every other segment of the population) of the “thin ideal”.   These beliefs and habits by adolescents are contributing to an increased prevalence of obesity, binge eating, starving, and purging.  Media that promote, indeed idolize, thinness as the body ideal have led to a preoccupation with body shape and weight among teens, both male and female.  The pursuit of the perfect body: thin with muscle definition.  But because they’re also facing a complex array of social, family and academic demands, many turn to food. 
Emotional eating causes a vicious cycle:  eating provides temporary stress relief, then anxiety and depression, purging and temporary relief again, until the next time.  And the cycle repeats.  They’ve learned nothing about emotion regulation or effective problem solving, only problem avoidance.  So if parents see odd eating habits in their teen’s eating, they should be concerned.  
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Advice to parents:

1. Resolve your own issues.  The thin ideal traps all of us to a greater or lesser extent.  Seek professional help if you need it.  You are the most important influence in your child’s eating attitudes and behavior.
2. Do not think of food as a reward or punishment.  It is neither.  Food is neutral.  Eat for the pleasure of taste and to satisfy hunger, not to cope with emotions.
3. Cook meals as often as possible and always include a protein.  See a nutritionist trained in eating disorders, not simply weight, if needed.
4. Neither tease nor praise them about their weight.  Find other wonderful ways to compliment them.  Keep weight and shape neutral topics.
5. Avoid using the word ‘diet’.  It’s an unwelcome four-letter word.  Talk about health instead.  Unfortunately, some teens interpret ‘healthy’ to mean ‘fat’, however, so watch their reactions.
6. Enlighten them about the subversive goals of the advertising and fashion industries, which primarily operate out of their own self- interest.  Encourage them to dress for the body they have, not the body they want.
7. Inform them (admittedly a hard sell, but important enough to try) that a computer screen at night in bed in the dark produces a mindlessness that can lead to overeating.
8. Most importantly, be positive and affirming.  No matter how challenging they sometimes can be, your adolescent children need you more than you may think.  They need you to be the consistent and loving parents you are already striving to be.

The Alarming Facts:

1. 46%of 9-11 year-olds are “sometimes” or “very often” on diets, and 82% percent of their families are “sometimes” or “very often” on diets (Gustafson-Larson & Terry. 1992).
2. 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 (Neumark-Sztainer, 2005).
3. 35-57%of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills or laxatives.  Overweight girls are more likely than normal weight girls to engage in such extreme dieting (Boutelle, Neumark-Sztainer, Story, and Resnick, 2002; Neumark-Sztainer & Hannan, 2001; Wertheim et al.,2009).
4. A 2006 survey by the National Eating Disorders Association (NEDA) found that nearly 20% of the more than 1,000 college student’s surveyed- both male and female- said they have or previously had an eating disorder.

The Hopeful Facts:
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1. Recovery from an eating disorder is a process.  It is difficult but achievable.  Early detection and intervention are particularly important.
2. Parents are not to blame.  You can be your children’s greatest allies in treatment.
3. Eating disorders affect people of all races, genders, ages, body shapes, weights and socioeconomic status.  Recovery is possible for all.
4. Teenagers with eating disorders are not weak-willed or lazy.  Their condition should not be considered a simple choice.  Eating disorders are biologically, psychologically and societally influenced illnesses.
5. An eating disorder diagnosis is a health crisis.  Find a trained eating disorder professional as soon as possible.  If you aren’t able to find a suitable local therapist, consult NEDA, the National Eating Disorders Association.

So, what’s the takeaway for parents?  You’re probably already on the right path by making your home a judgment-free food zone.  Enjoy food, even love it.  But keep eating in perspective.  There are many ways to create a delicious and meaningful life.  Explore your own non-food interests and talents and invite your teenagers to join you.  If they’re not interested (and there’s a good chance they won’t be, let’s be real!), have fun with and without food.  Make your own life interesting and meaningful.  They’ll notice. Remember, you influence them more than anyone in their world.  Have fun, and bon appetite!