This week I reached out to Wendy Sterling, RD and Signe Darpinian, a certified eating disorders specialist, and authors of No Weigh! A Teen’s Guide to Body Image, Food, and Emotional Wisdom to get some advice that parents can use when they are concerned if their child has an eating disorder and how to promote a healthy food environment at home.
What's one piece of advice you'd offer to parents who are concerned about one of their children possibly have an eating disorder?
Listen to your instincts. If something feels “off,” it certainly would seem worth investigating – after all, parents know their child better than anyone else, and can sense when even the slightest behavior seems different. Research shows that the sooner an adolescent gets treatment for an eating disorder, the better the prognosis. Given that warning signs vary across eating disorders, our advice would be to look out for behaviors like “healthy eating,” excessive preoccupation with weight and shape, restrictive eating patterns such cutting out food groups or skipping meals, exercising beyond one’s usual routine, any large fluctuations in weight, or delayed growth. This is trickier than it sounds because adolescence brings with it pubertal changes that result in what can be a complete metamorphosis to one’s body. And eating healthfully is a common conversation in most households, so some of these warning signs, can easily sneak under the radar. Parents should watch for extremes in behavior and exaggerated food rules for example where kids will “never” eat a certain food or “only” have a certain type of lunch. It is not healthy to only eat healthy.
If you find you have reason to intervene early, take your child to a health professional like your pediatrician, where your child’s growth and vital signs can be assessed. And if everything turns out to be fine, What a relief! Your actions will send the message to your child that health is prioritized. And one note – we recommend calling the doctor’s office ahead of time to make sure they have a weight inclusive approach and that they are educated about eating disorders. If weight is dealt with in a stigmatizing way it can make the problem much worse. The good news is that there are many healthcare providers making a paradigm shift to non-diet, Body Positive, Health at Every Size® approach, which supports people of all sizes in finding overall intuitive self-care. This helps to reduce risk factors for the development of eating disorders.
How can parents ensure they create a healthy but relaxed and open food environment at home to help prevent a child developing an eating disorder?
Those who are diagnosed with eating disorders may have a combination of factors that create “the perfect storm” for these illnesses to develop. These factors can be: one’s individual traits, genes, psychological make up; already existing co-morbidities such as depression, anxiety, OCD; plus external factors such as cultural cues, dieting/social pressure, a “perceived pressure for thinness,” and body dissatisfaction. Parents can take actions to minimize risk factors for development of an eating disorder in their child. Providing protective factors in the home might sound easy, but it is not simple, given we are all swimming in diet culture.
3 Tips for Body-Positive Parenting:
1. Cultivate a Friendship with Food/Body (protective factor against dieting):
Modeling protective factors look like practicing “connected eating” yourself. “Connected Eating” in a nutshell, is a non-diet approach to food: eating in response to the body’s wisdom, identifying manageable hunger, "deciding from the inside" what you'd like to eat, and stopping at just enough. Now of course you could turn connected eating into a diet in a nanosecond, so it’s important to consider each meal as a new opportunity to get a little closer to eating in an attuned way. Polarizing foods (talking about “good foods and bad foods”) disconnects us from our body’s true wisdom and often indirectly reinforces messaging about dieting and losing weight. Talking about “fattening foods” is scientifically untrue; "fat in food does not make you fat" since no one food has the power to cause weight gain. This language teaches kids to fear foods, to tiptoe around eating, and inherently gives the indirect message that fat is bad, and thin is good.
You cannot fail at connected eating. If you can fail at any particular food plan you are doing, it’s a diet. Getting back to what the body already knows how to do is a process, not a finished product. It requires having a friendship with both your food and your body, and friendships are reciprocal relationships that flourish with good listening skills, enjoyment and respect. And like your friends, there are going to be times that we don’t like our body, and that’s to be expected. We do still need to treat our bodies (and friends) with respect even when we don’t like them - that way we have a quicker return to that baseline relationship. But what if you, as the parent, are not okay with your natural weight? That’s certainly understandable, and you do not need to be all the way there to initiate this practice/process. Grieving the loss of the ideal body you’d hoped to have is an “active” process of Body Tolerance/Acceptance/ Love and is well worth it. We take better care of things we love.
2. Create a Judgment-Free House (protective factor against “perceived pressure for thinness”):
Creating a house that is a judgment-free zone, also free of get-thin messages, allows kids to grow up more peacefully with their body regardless of what sized body they have. This is important, especially during adolescence, when kids may feel uncomfortable and confused by their changing bodies. Make home a place of “safety,” free of conversation about how your child’s body looks, should look, how you look, how your clothes fit, or how others looks, and free of thin-biases. Teach kids that “all bodies are good bodies,” and that if their body is bigger, or smaller, or changing sizes in any way, you will love them no matter what. But walking your talk is necessary. Kids have an incredible sense and can sniff out any incongruencies in what we are saying and doing. If you want to raise kids who feel good about their bodies, then the belief system has to be real. When parents talk at the dinner table and comment about people’s weight and say, “Did you see __, he/she/them looks great!” that comment automatically glamorizes thinness, sending a message to kids that thinness is idealized and valued, and if the child wants to be praised and adored, s/he/them “should be” thin. Even saying things such as "no, that does not make you look fat," stigmatizes fat, suggesting there is “something wrong” with a higher weight. Risk factors for the development of an eating disorder include the pressure to be thin, body image dissatisfaction, and dieting. Realistically, you are not going to be able to keep your child from destructive messages from the culture or other kids, but you can build resilience within them as well as model the behaviors you want to grow in your home.
3. Teach kids about joyful movement (protective against compulsive exercise, exercise burnout or avoidance, stress, anxiety, depression, sleep deprivation…)
Exercising to burn calories, lose weight, or alter one’s appearance creates an unhealthy relationship with physical activity. Linking exercise to food intake in any way (“I ate so much today, so I’m going to go exercise”) teaches kids that they should compensate for food consumed with exercise, which is a dangerous and disturbing message, and over time, potentially can lead to the development of an eating disorder. There are many wonderful benefits of exercise on which parents instead can focus such as an improvement in: mood, energy, sleep, and stress relief. In fact, it is well documented that individuals who exercise for internal goals such as the way it feels, camaraderie, energy, stress relief are more likely to continue their habit of moving versus those who exercise based on external goals such as the pursuit of thinness.
Teaching kids that all foods can be incorporated into a healthy diet (that all “fare is fair”) and that exercise can be joyful and part of a healthy lifestyle will help to encourage a peaceful relationship to food/body. Eating in an attuned way, being mindful of how you speak about your body as well as others’, and reducing the risk factor of body image dissatisfaction (and a whole lot more) will provide protective factors against your child developing an eating disorder.
Wendy Sterling, MS, RD, CSSD
Wendy Sterling is a registered dietitian and board-certified specialist in Sports Dietetics. She is the co-author of How to Nourish Your Child Through an Eating Disorder: A Simple, Plate-by-Plate Approach to Rebuilding a Healthy Relationship with Food and No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom. She worked at The Healthy Teen Project as well as the Eating Disorder Center at Cohen Children’s Medical Center of New York. Her research on osteoporosis, menstruation and metabolism has been published in the International Journal of Eating Disorders and the Journal of Adolescent Health. She was most recently published in the Journal of the Academy of Nutrition and Dietetics for her work with the Plate-by-Plate approach in Fall 2018. She is the team nutritionist for the Oakland A’s.
Signe Darpinian is a Licensed Marriage and Family Therapist and Certified Eating Disorders Specialist iaedp™ Approved Supervisor (CEDS-S). She is also a public speaker and a co-author of No Weigh! A Teen’s Guide to Positive Body Image, Food, and Emotional Wisdom with Jessica Kingsley Publishers in London. Signe has been treating eating disorders for over 15 years and has private practice offices in two California locations: The Central Valley and The SF Bay Area. She is also the President of the International Association of Eating Disorders Professionals SF Bay Area Chapter and she serves on The Body Positive Partnership Council.
FB: Signe Darpinian