With the start of each new year, self-improvement and weight loss advertisements flood the airwaves. The $72 billion dollar weight loss industry bombards all of us with messages telling us our body is wrong and our food is wrong, leading to an ever-vicious cycle of food confusion and body dissatisfaction. Parents who might be struggling with their own body and relationship with food may desperately wish to help their kids develop a more peaceful relationship with food and body — but how? We caught up with dietitian Wendy Sterling, therapist Signe Darpinian and adolescent medicine doctor Shelley Aggarwal to hear how parents and teens can practice diet-free living and improve body image satisfaction.
Can you explain what you mean when you encourage readers of Raising Body Positive Teens to have a "friendship with their body and food"?
Friendship is the perfect metaphor for the relationship between one's body and food. A healthy friendship is generally defined by mutual respect, trust, joy and good listening skills. Our best friendships bring out a true enjoyment of each other's company. If we examine our relationship with food through the lens of respect, trust, joy and good listening, it's easy to conclude that many of us don't have the healthiest friendship with food. Raising Body Positive Teens takes aim at the unfriendly relationships we may have with food and our bodies.
Our body is a skilled regulator — when allowed to be — and you can really learn to trust its wisdom. Treat your body with respect, even though you may not always like it. Looking again at friendships, we know that we can, at times, fall out of "like" with our friends. However, if we can continue to treat our friends with respect, it is easier to find our way back to our baseline relationship with them. This same principle can be applied to body image.
What happens if you are not eating enough to meet your needs?
Adequate nutrition is fundamental to healthy development and maximizing one's physical potential. Like a plant that requires sunlight, air, soil and water, bodies need food, vitamins, minerals, fats, carbohydrates, proteins and many other nutrients to grow. In addition to a variety of foods, we must eat enough food. Eating too little can interrupt growth and development and impact a child's current health and long-term health.
Not eating enough food can affect cardiac, gastrointestinal, menstrual, hematological, immunological and psychological functioning. For instance, an athlete who is not properly fueling may find their performance falling off: they may feel slower, weaker, be more prone to injury and might not make progress despite extensive training. In addition, they may be more irritable and depressed and have decreased endurance and more trouble recovering.
What is a non-dietary approach to health?
A non-dietary approach to health looks at the whole person and the many factors that create one's well-being without emphasizing weight or dieting. Unfortunately, there is an overemphasis on weight in our culture, which is also embedded in the medical culture. A non-dietary approach looks at factors other than food that affect physical and emotional health. These can include stress, happiness, sleep, moving joyfully, mindfulness practices, support through and access to mental health resources, connections to others—and much more.
Who is at risk of an eating disorder?
Eating disorders affect people of all sizes, genders, races, ethnicities and ages. You don't have to be "emaciated" to have an eating disorder. In fact, fewer than 6% of those diagnosed with an eating disorder are considered clinically "underweight" (Flament et al. 2015). This means you can't tell just by looking at someone if they are sick or the degree to which they are sick. Many believe they "can't possibly be sick enough to warrant treatment." Or worse, their clinician misses the eating disorder altogether. Frequently overlooked populations include males, those in larger bodies, Black, Indigenous and people of color (BIPOC), and older folks.
Cultural values or expectations around privacy and stigma around mental health, combined with a lack of knowledge and difficulties and inequities in accessing health care, all impact the likelihood that someone will receive the help they need. Delaying the recognition and/or treatment of an eating disorder makes it harder to treat and ultimately requires more intervention.
What causes an eating disorder?
There are many reasons why people develop eating disorders. It is often the result of a variety of factors like one's genetic makeup, personal characteristics (like whether someone is perfectionistic, anxious or depressed) and the impact of new medical diagnoses such as gastrointestinal issues. One's family life (e.g., divorce, death), trauma, social and environmental factors (like whether one's friends are dieting or bullying), weight stigma and the effects of a global pandemic can also play a role. It's so complicated. We also know that dieting is one of the biggest predictors of an eating disorder. So, the language used in the home, on the field or in school can be protective against the development of an eating disorder.
What does having an eating disorder "look" like?
Eating disorder characteristics can be categorized as follows: physical signs, behaviors around food, exercise, body image and cognitive/mood changes. Here are some warning signs to look out for:
Increased interest in food and exercise (becomes a red flag when it turns into an obsession)
Sorting foods into "good foods and bad foods" and talking about being "scared" or "fearful" of foods
Increased focus on body and shape (some of this is normal during adolescence, but a high degree of distress and preoccupation would be concerning)
Body checking (repeatedly touching, examining and dissecting the body in the mirror)
Changes in weight
Loss of menstrual cycle, unrelated to perimenopause/menopause. While considered "common" among athletes, it is not normal and is usually a sign that something is "off" physiologically
Obsessive thinking
Increased rigidity and lack of flexibility
Using food to cope with emotions
Lack of spontaneity around food
Lack of variety in the diet—a change from an earlier diet
Avoidance of social situations, especially where food is involved
Compensatory behaviors (Defined as those used to eliminate the calories being consumed; it is a hallmark feature of Bulimia Nervosa but is also present in other types of eating disorders, such as Anorexia Nervosa or Binge Eating Disorder. Compensatory behaviors can take the form of vomiting after meals, exercising excessively, restricting food, or misusing laxatives, diuretics, diet pills and teas.)
Social media can negatively influence body image. How should we navigate this?
Apps like Instagram and TikTok can be harmful, depending on how they are being used. Social media influencers are often trusted, yet many are not credentialed and do not provide evidence-based information. Follow people who motivate and inspire you. Ask yourself whom you are following and why. How do certain accounts make you feel? Do you feel worse after looking at specific images? Or do you feel like you need to change something about yourself?
It's well documented that many images are photoshopped, Facetuned and altered (or entirely generated by AI), presenting a false and unachievable appearance of body perfection, fitness and youth. Don't be afraid to click unfollow! Images, especially those promoting weight loss, diets and particular physiques, may offer dangerous "how-tos" for the development of disordered eating/eating disorders.
It's helpful to diversify your feed to include a variety of body types, people and areas of interest in addition to beauty and exercise. Studies show that when people are exposed to images featuring a wide range of body sizes for a mere 20 minutes, their body size preferences shift to be more inclusive.
You can follow accounts highlighting travel, hobbies, sports, art, nature, etc. Becoming a critical media viewer is a great way to build resilience against the barrage of messages about diet culture, beauty and health. Examine the TV shows and movies you watch. You can start by pointing out shows that make larger bodies the punchline when you see them — exposure matters. Look for TV shows that depict diverse bodies, such as Shrill (based on the book by Lindy West) or Lizzo's Watch Out for the Big Grrrls.
How do you raise a body-positive teen if you, as a parent, have had lifelong body image, weight and eating concerns?
The first step to raising a body-positive teen is to bring awareness to the issue. Awareness lets you choose whether and how you want to think, feel and/or behave differently. In our culture, we often react and speak unconsciously to messages about food and body—as if we are on autopilot. We are steeped in these messages through pop culture, images, music and day-to-day conversation, and we rarely question their validity or benefit. We then pass on these weight, shape and food concerns to our children. In our book, we encourage parents, as a first step, to bring awareness to how they engage with their own ideas of food and body.
To get started, a family might commit to taking the morality out of food. This means including all types of food in the house and avoiding labeling foods as "healthy," "unhealthy" or "junk food." Similarly, families could consider creating a joyful movement routine. They might choose activities that sound fun over those that will "burn more calories." They can focus more on being together in nature than "earning the ice cream" after the hike.
People of all shapes and sizes can have a positive body image and healthy self-respect. However, many cultures believe those who don't look a certain way shouldn't feel good about who they are. By rejecting constricted ideas of beauty and expanding the definition of what it means to be someone who is thriving and appreciative of their physical appearance, we can decrease our stress and create a more inclusive paradigm. —Excerpted from Raising Body Positive Teens
Resources
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Signe Darpinian, LMFT, CEDS, Wendy Sterling, MS, RD, CSSD, CEDS-S, & Shelley Aggarwal, MD
Signe Darpinian is a Licensed Marriage and Family Therapist (LMFT), Certified Eating Disorders Specialist (CEDS) and host of Therapy Rocks!, a personal growth podcast. Signe is also the former president of the San Francisco Bay Area Chapter of the International Association of Eating Disorders Professionals and provides telehealth therapy services in California.
Instagram @therapyrockspodcast and @noweighguide
Wendy Sterling specializes in adolescent nutrition, eating disorders and sports nutrition. She is a Certified Eating Disorder Registered Dietitian and a Board-Certified Specialist in Sports Dietetics from the San Francisco Bay Area. She has consulted for the Oakland Athletics, Golden State Warriors, NY Jets and NY Islanders. She is the co-author of How to Nourish Your Child Through an Eating Disorder and How to Nourish Yourself Through an Eating Disorder.
Instagram: @wendy_sterling and @platebyplateapproach
X: @WendyMSRD
Shelley Aggarwal is a physician, board-certified pediatrician and adolescent medicine sub-specialist. She treats medically complex teens and young adults and consults on youth-specific health issues, including adolescent development. Shelley has worked with premiere academic institutions and is on the teaching faculty with Stanford Children's Health and UCSF-Fresno. She is the medical director of clinics serving justice-involved youth.