Ages + Stages | Health and Development | Tweens + Teens | Ages 11–14 | Ages 15–18

Weight Worries and Body-Image Secrets

How boys and girls are at risk for eating disorders

When Seattle mom Julia Ramirez’s* 12-year-old daughter started running for hours every week, stopped eating fats and carbs, and was often too busy to sit down at the family table for a meal, Ramirez assumed that her girl was just “growing up” and trying to shed a bit of her “baby weight.”

But the tween’s habits became more intense until, just after her 13th birthday, she became so sick and stressed that her secret life came tumbling out, and her mom brought her to a clinic for help. 

“My baby got really sick, and I still feel so guilty, because for a long time I had no idea,” Ramirez says. “Now, we take it day by day.”

Many parents assume that if their child was developing an eating disorder, it would be obvious. But in fact, so many of the would-be signs are easily excused, downplayed or concealed. How common is it for a busy kid to brush off a family dinner, or skip a full meal at lunch, because she’s got homework, soccer practice or is “just not that hungry”? Been there, heard that.

Eating disorders can happen under anybody’s nose. Certainly, sometimes kids are just being kids. But sometimes, experts say, it’s more.

“If you are a family that typically eats their meals together and your child does not want to eat with you, if they’re too busy, if they used to eat everything and now suddenly they’re vegan — that could be a sign,” says Neeru Bakshi, M.D., medical director of Eating Recovery Center of Washington. “Talk to your child. With the busyness of parents, you can get lost in the day to day, and not really notice the things in front of you.”

Weight starting younger, for boys and girls

Eating disorders such as anorexia and bulimia are not new. But trends ebb and flow, and current trends include a younger generation of kids more hyperaware, thanks in part to social media, of negative messages around body image.

“We are seeing kids younger and younger. It used to be that a young patient was 12 or 13; now a young patient is 8 or 9,” says Jillian Lampert, Ph.D., chief strategy officer for The Emily Program, which has clinics in Washington state, Minnesota and Ohio, and offers residential, partial and outpatient treatment as well as specialized youth programs. “It’s not entirely clear why that’s the case. But the emphasis on weight and eating right has increased over the last couple of years. Now restaurants and stores are labeling calories.” There’s a good aspect to that, of course, Lampert says. But it’s also putting more pressure on us, young people especially. “There’s just so much more focus on what we are eating.”

Among elementary school girls, 40–60 percent are concerned about their weight or about becoming too fat, according to a 2011 study cited by The National Eating Disorders Association.

“Social media really has created a sense of community that wasn’t there before,” Bakshi says. “There is a very loud pro-eating-disorder community out there, but there isn’t a loud pro-recovery voice.”

Lampert, who has three daughters in grade school, says she just heard a story of a fourth-grader being told by a friend at the school lunch table, “You’re fat. You need to go on a diet.”

“Then she said, ‘I’m just kidding, I’m just being funny.’ This type of thing probably happens every day — and while that alone doesn’t lead to an eating disorder, for people who are susceptible, it can change the way they think.”

Another trend parents need to know about: boys.

“People think it’s just girls, but boys are in our clinic all the time,” Bakshi says. “And athletes. They are driven to have a perfect body, and it’s impossible.”

Currently about 8 percent of adolescent girls and 4 percent of adolescent boys have an eating disorder, Lampert says. And 8 percent of high school males surveyed in Seattle said they did not eat for 24 or more hours to lose weight or to keep from gaining weight, according to the Centers for Disease Control and Prevention’s 2011 Youth Risk Behavior Survey.

Body-image issues: Anorexia, bulimia, orthorexia

Many parents know something about anorexia and bulimia, two of the most common types of eating disorders. But other iterations are less commonly known, such as orthorexia (an unhealthy obsession with eating otherwise healthy food), Bakshi says. “It’s not an official diagnosis. But eating certain things at certain times, having anxiety around your typical patterns being disrupted, exercise and eating” — these could all be cause for concern.

The terms can be confusing, agrees Lampert. Binge eating disorder (BED), for example, was officially included in the Diagnostic and Statistical Manual of Mental Disorders 5 as a standalone diagnosis just last spring. “It gets kind of caught up in our confusion about weight, weight loss and emotional eating. Binge eating is when food is soothing a person; they’re overeating for comfort, they feel out of control. It’s not just your garden-variety big-Thanksgiving-meal overeating. It’s repeated,” Lampert says. And it’s potentially hard to spot. “Somebody at a reasonable weight could be throwing up every day, could be binge eating or withholding food.”

So, what is the root cause of an eating disorder?

“There is no real root. But we do look at things like: What’s the child’s temperament? How are they hard-wired? Are they always wanting to be in control? They might lean toward anorexia,” Bakshi says. “Are they always wanting to avoid negative consequences? Then they might lean toward bulimia.”

And, experts agree, so much of it has to do with self-image and modeling.

“Look at our culture. With my mother — we bonded around food. And we bonded around the diet. We would eat a beautiful meal, and then my mother would say, ‘Oh, I shouldn’t have eaten that,’” recalls Robyn Cruze, a recovery advocate and author of Making Peace with Your Plate.

Cruze was sick from ages 11 to 29 and nearly died of her disease. “There’s such shame. My behavior was hiding depression, anxiety and trauma. It was like I was swimming in the river, and only my nostrils were above water, and I was flailing.”

A healthy home

Parents should think carefully about how they model a relationship with food and their body to their children, experts say. It might sound corny, but it’s true: Self-love begins at home.

One important rule: There are no “good foods” or “bad foods.”

“We have friends who come to our home and say, ‘I can’t eat that — it’s fattening.’ And I just gently say, ‘In our home, there’s no good or bad food,’ says Cruze, who has two grade-school-age children. “I tell [my children] their bodies are so amazing. And it’s not just mothers who need to do this. Fathers need to be more mindful, too. No fat talk!”

“If you think your kid might be struggling, bring them in for an assessment,” Lampert urges parents. Specifically, she says, schedule an eating disorder assessment. “Most general physicians aren’t well-trained in eating disorders.”

Lampert recommends that parents of tweens and teens ask their children how their friends and other kids at school talk about health and weight, or if anyone is teased. “Weight bullying is sometimes [more] overlooked than other types of bullying. Because we’re so focused on weight in our society, we sometimes don’t hear that.”

Ask about lunch: Do the kids eat? Middle school girls often don’t eat lunch, just a container of yogurt. “They’re probably going to be hungry. They need to eat real food,” Lampert says.

Parents can also get athletic coaches on their side, encouraging positive talk about eating healthfully and feeding active bodies properly.

And at home, Lampert says, “Focus on what you want [your kids] to do, not what you want them to do less of. Focus on ‘We’re going to eat more fruit,’ not ‘We’re going to eat less cookies.’ It will balance itself out without having to vilify the food you want less of. [Tell them,] ‘Let’s eat these things because they give us energy and they make our bodies strong.’”

Tips to avoid body-image issues

  • Have as many family meals together each week as possible.
  • Make sure that a variety of foods are offered and accepted in the household.
  • Stop making disparaging comments about weight or appearance.
  • Emphasize the importance of body acceptance.
  • Educate girls and boys about normal change and body development, especially preparing them for puberty.
  • Teach kids critical thinking skills about images they see in the media.
  • Prepare kids for negative “chatter” that they will hear from peers about food, weight and appearance.

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