How to Identify and Prevent Eating Disorders in Kids
Kids and parents are constantly bombarded with messages about healthy eating and exercise. Documentaries about the dangers of our food supply abound on Netflix. Smartphones have built-in health apps and watches can track calories and exercise behaviors. As a society it seems that we have gone from one extreme to the other. When my daughter was in kindergarten, I bemoaned the fact that school food came out of cans, PE was only once a week and recess was considered a waste of valuable study time.
Fast forward to 2017 and schools have gone from nutrition wastelands chock full of candy and donuts to employing chefs who use locally sourced produce and offer vegan options. Cross fit and 5K training are the norm in PE classes. Elementary school aged children are being warned about eating too much sugar, fat, and red meat. They are asked to count calories, have the right combination of protein, carbs, and greens on their plates and get at least one hour of aerobic exercise daily.
New Dangers for Kids
Unfortunately, there is a downside to our increased focus on healthy eating and fitness. If you are overwhelmed by all these messages, imagine how it feels to a child in the throes of puberty who is also dealing with peer pressure, academic stress, and social media. It’s a veritable minefield creating a lot of fear and worry in a population that already has enough stress.
Studies confirm this increase in stress among children and adolescents. Forty five percent of teens (ages 13-17) say they were more worried in 2009 than they had been the previous year, according to a 2009 report from the American Psychological Association (APA). The study also found that 25 percent of tweens and 39 percent of teens reported eating too much or too little due to stress. However, only 28 percent of parents thought their teen’s stress had increased and a mere eight percent reported being aware of their child’s eating issues.
I am not denying that healthy eating and exercise are important but for certain youth, a heightened focus on health could be one of many factors that contributes to the development of an eating disorder.
At-Risk Traits That Can Lead to an Eating Disorder
Your child may be at risk of an eating disorder if they exhibit the following characteristics/temperament:
- High achiever
- Obsessive tendencies, a need to be in control
- Difficulty handling change
- Black-and-white thinking
- Emotionally sensitive but has difficulty expressing emotions
- Rule follower
- People pleaser
- Low self-esteem
- Depression, anxiety
The combination of environmental stress, temperament, and societal pressure to have perfect physiques (thin, sexy, and athletic but not too muscular with a flawless complexion for girls; thin, muscular with six pack abs, and perfect skin for boys) is the perfect storm for the development of an eating disorder.
An eating disorder becomes a coping mechanism—an outlet for stress. For those who are prone to undereating, the act of restricting serves to temporarily reduce their anxiety and stress. When you add exercise to the mix, it actually serves to calm the brain (temporarily). For others who are prone to overeating, food serves as a comfort and helps relieve stress (again temporarily).
Warning Signs for Eating Disorders in Kids
Take note of the following warning signs that may indicate an eating disorder:
- Dramatic weight loss
- Dresses in layers to hide weight loss
- Eliminates foods and entire food groups (e.g., carbohydrates, dairy, gluten, fat, animal products)
- Makes excuses to avoid mealtimes
- Cooks meals for others without eating the food they prepare
- Complains of constipation, abdominal pain
- Food rituals (e.g., eating foods in certain orders, rearranging food on the plate)
- Excessive use of fat-free condiments (hot sauce, salt, vinegar, salsa)
- Excessive, rigid exercise routines despite weather, fatigue, illness, or injury—has the need to “burn off calories” after eating
- Isolates from friends
- Refuses to eat in public
- Increased anxiety, depression, obsessive thoughts about food, weight, shape, appearance
- Is either lethargic or overly active, restless, can’t sit still
- Obsessive about fitness apps, use of fitness trackers
- Increased interest in recipes, food shows
- Weight loss, dieting, and control of food are primary concerns
- Disappearance of large amounts of food in short periods of time, empty wrappers in bedroom, car, bathroom
- Spending excess time in bathroom with shower running
- Evidence of laxative or diuretic use
- Steals or hoards food in unusual places (under bed, in car, backpacks, drawers)
- Uses excessive amounts of mouthwash, mints, gum
- Unusual swelling of cheeks, jaw
- Discolored teeth
- Calluses on back of hands
- Avoids eating normal amounts of food in front of others, skips meals
- Diets often
Binge Eating Disorder
- Eating large amounts of food even when not hungry
- Eating until uncomfortably full
- Eating alone due to feeling embarrassed by how much one is eating or ashamed of eating in front of others
- Leaving empty wrappers in the bedroom, car, or bathroom
- Steals or hoards food in unusual places (under bed, in car, backpacks, drawers)
- Feeling disgusted with oneself, depressed or guilty after eating
- Eating late at night after others have gone to bed
- Constant dieting
Avoidant and Restrictive Feeding and Intake Disorder
Another eating disorder that is commonly mistaken for picky eating is Avoidant and Restrictive Feeding and Intake Disorder (ARFID). A child with ARFID may display the following behaviors:
- Avoiding certain colors, tastes, or textures of food (e.g., crunchy or colorful vegetables or meat)
- Fear of eating after an episode of choking or swallowing
- Inability to gain expected amount of weight for developmental stage
- Anxiety about eating in social situations
Orthorexia is another condition that is becoming more prevalent in children and adolescents. Clean eating has become a way of life for many. Again, there’s nothing wrong with eating healthy, but when it becomes an obsession and interferes with relationships and activities it has gone too far.
Warning Signs of Orthorexia:
- Elimination of certain food groups for the sake of health and purity
- Refusal to eat any foods not considered healthy or clean
- Shame, anxiety, physical discomfort, guilt after eating certain foods
- Weight loss that is not intentional
- Wanting/needing to prepare own food
- Avoidance of eating in social settings
If you notice any of these warning signs, seek professional help. If your doctor doesn’t take you seriously, search for an eating disorder expert. Many parents erroneously believe that once their child knows they have a problem they will be able to self-correct.
In my 20 years as an eating disorder specialist, I have heard many parents say their biggest regret was not seeking help for their child sooner. The longer the symptoms endure the harder it is to treat, and the more probability that your child could suffer health complications including permanent bone loss, cognitive impairment, infertility, and even death.
An eating disorder diagnosis tears apart families particularly if treatment is delayed. If your child had cancer, you would probably seek immediate treatment. There is no soccer game, exam, vacation, or graduation more important than your child’s long-term health.
How to Prevent Eating Disorders in Kids
What can families do to prevent eating disorders?
- Eat together, make family meals a priority
- Enjoy all food groups in moderation (yes that includes donuts and French fries)—model eating all types of foods in front of your children
- Refrain from over-focus on food and exercise
- Make exercise enjoyable rather than achievement focused (go for family bike rides, take walks in nature)
- Reduce stress by spending more time relaxing
- Limit conversation about weight, shape, appearance, and health, and instead focus on inner qualities and values
Executive Director, Eating Recovery Center, The Carolina’s, Beth Riley is a certified eating disorder specialist (CEDS) and a CEDS supervisor through the International Association of Eating Disorders Professionals. She is also a Master of Social Work field placement supervisor for the University of South Carolina School of Social Work. Beth graduated with distinction from Stanford University and earned a master’s degree in social work from the University of South Carolina. She has been practicing for 20 years and has developed a local, regional, and national reputation as a leader in clinical excellence and innovation in the field of eating disorders. She frequently lectures at regional hospitals and for healthcare providers.