Editor's note: This article was sponsored by THIRA Health.
After a year and a half of enduring pandemic-related constraints, our kids are far from alright. Cut off from the rest of the world during shelter-in-place orders and school closures, many adolescents in particular are experiencing a mental health crisis. Doctors nationwide have witnessed alarming increases in youth hospitalizations and outpatient visits due to acute anxiety and stress. And although social distancing proved to be one of the best ways to prevent the spread of the coronavirus, the resulting isolation has negatively impacted kids’ mental health and overall well-being in a wide range of ways.
For many teens, the pandemic has catalyzed new — or exacerbated existing — cases of anxiety, depression and eating disorders. In fact, the clinicians at THIRA Health say that they have seen a marked uptick in both the frequency and severity of eating disorders of all types (anorexia, bulimia, binge-eating disorder and orthorexia; see sidebar below).
Why the increase? THIRA Health Clinical Director Sarah Skoterro, LPCC, LADAC, says that pandemic-sequestered kids haven’t had the sense of visibility — that feeling of being seen and understood — that they would ordinarily benefit from when they’re surrounded by peers at school. Stuck at home with suspended schedules and often no routine to speak of (not to mention little to no interpersonal connection), many have felt utterly alone and have struggled to cope. In such circumstances, regulating food intake and becoming hypervigilant over body weight can become a way for some to regain a sense of control over their life. But doing so can land kids in dangerous territory.
Behaviors and signs that may indicate an eating disorder
The earlier an eating disorder is diagnosed and addressed, the greater the odds are of recovery, so it’s important to know the signs. Whether you’re worried that your child may have an eating disorder or you’re not quite sure how to tell, there is help. Experts from THIRA Health lay out what signs of eating disorders to look out for, plus how to help when your teen is struggling with one.
A preoccupation with dieting and weight loss, controlling food intake, limiting calories or restricting macronutrients (carbohydrates, proteins, fats) are behaviors that may signal an eating disorder. Parents should pay particular attention to any changes in their child’s weight (gain or loss) and notice if they’ve developed a newfound rigidity over food, says THIRA Health Head Dietitian Diana Chislett.
“Look for empty wrappers or food packages that may be hidden in the garbage. There’s a lot of shame associated with eating,” says Chislett, adding that strict rules about what foods they allow themselves to eat (and when they can eat them) are indications that an eating disorder may be a factor. If a child develops new food rituals, starts skipping meals, or is eating less overall, it may be time to intervene.
Other signs are isolating behaviors such as not participating in family meals, Skoterro says. That could mean your child is taking food to their room, eating in secret or at night, and even lying about food that is missing after they binge. “If you ask your child what happened to the whole box of Oreos [that is missing], and they say they don’t know, something’s going on,” she says.
Vomiting is another red flag. “When kids are throwing up a lot, [it leaves] an oily residue in the sink or toilet. Parents of teens might see that, and they should ask their teen if they were just sick. If it looks like somebody just vomited, they did,” says Skoterro.
Over-exercising is a compensatory behavior that’s often overlooked, but this, too, is a key sign of an eating disorder such as bulimia. But how much is too much?
“Exercise is not good if it’s done at the expense of food and hydration and social interaction. So, has there been a change in frequency, and does your child seem like they enjoy it? Be aware of whether they’re exhausted or in pain, if they have an injury and they’re still exercising, and whether they do it alone or at night,” says Chislett.
Most importantly, pay attention to any changes in your child’s eating habits and attitude toward food. If they’re stressed about every meal all of a sudden, it’s time for a conversation.
What to do if you think your child has an eating disorder
Parents play an important role when it comes to their child’s eating disorder recovery. Speak about food in a very organic, natural way; promote it as energy, says Skoterro. “Parents can calm the temperature down about food and eating. There should be no judgment at home. Be a role model that food is enjoyable, that food is fun.”
If you suspect something is off, Skoterro advises that parents be specific. “Kids really need to be seen. Say, ‘Hey, hold on a minute. I really see you. I see that you’re not eating like you did before. I notice that you’re not eating Pop Tarts for breakfast anymore, and you loved them.’ It’s 'care-fronting' versus confronting.”
Chislett says that using treats like ice cream to cope is okay from time to time, but food shouldn’t be a child’s only coping mechanism. Rather, parents should teach their kids that they’re allowed to talk about their emotions even when it’s uncomfortable.
“Talking about how your own day went and openly showing your vulnerabilities helps your child learn how to deal with their emotions in healthy ways. Make yourself available to your child. Sometimes you may not understand what your kid is going through, but you don’t shame them or shut them out; you calmly and rationally find a way to connect with them,” says Chislett.
If your child is exhibiting one or more behaviors that are indicative of an eating disorder, the best thing you can do is to seek help from a qualified professional. For a good starting point, access this free screening tool from the National Eating Disorders Association.
Eating Disorders, Decoded
Most frequently occurring in adolescence, anorexia nervosa is characterized by body dysmorphia (a distorted body image) and weight loss (often extreme). Individuals with anorexia typically restrict their food and have an intense fear of gaining weight. They might sometimes use vomiting, laxatives or compulsive exercise to compensate after they binge-eat.
The eating disorder bulimia nervosa involves the act of binging and then purging at least once a week for more than three months. A binge involves a loss of control over one’s food intake; much more food than normal is consumed within a two-hour window. After the binge, the individual will fast, vomit, use laxatives or diuretics, or over-exercise in order to compensate for their excess food intake.
Orthorexia involves an obsession with healthy or clean eating. Individuals with orthorexia may fixate on food nutrition labels, cut out entire food groups (such as carbohydrates, dairy or sugar) and become distressed when their preferred foods are not available.
People with binge-eating disorder exhibit behaviors similar to bulimia, but they do not purge after a binge. Typically, they consume much more food than normal (even when they are not hungry) until they are uncomfortably full, with no control over their eating. They may experience depression, guilt or shame after a binge, which usually occurs in secret.