According to the Centers for Disease Control (CDC), one in five school-aged children is obese. Most parents are hyper-aware of America’s childhood obesity epidemic, and work hard to ensure that their children learn healthy eating habits at an early age. However, what’s less apparent is the prevalence of fledgling eating disorders in the very young.
Much is still unknown about why eating disorders occur in some children and not others. Genetics play a strong role in determining risk, but it isn’t an insurmountable destiny. In fact, parents and child care professionals can play a huge role in helping kids avoid — or even overcome — an eating disorder, no matter their age. The key is in knowing what signs to look for and knowing what to do when you see them.
What are eating disorders?
According to the National Eating Disorders Association (NEDA), “Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. Eating disorders — such as anorexia, bulimia, and binge-eating disorder — include extreme emotions, attitudes, and behaviors surrounding weight and food issues.” They may be coupled with high levels of anxiety, or with specific anxiety disorders like obsessive compulsive disorder (OCD).
There are several different types of eating disorders. Most can occur, or start to occur, in children as young as 8 years old, or even younger. They include:
- Anorexia nervosa: Extreme weight loss, coupled with a distorted body image and extreme fear about weight gain.
- Bulimia nervosa: Extreme overeating followed by purging behaviors, such as vomiting.
- Binge-eating disorder: Extreme overeating that is not followed by purging behaviors.
- Overnight binge eating: Extreme overeating during nighttime hours typically not followed by purging behaviors.
According to the Alliance for Eating Disorders, “Contrary to popular belief, an eating disorder is not based on food. There are several contributing factors that may lead to the emergence of an eating disorder although no defined cause has been established. Contributing factors include:
- Biological factors: Eating disorders often run in families. The risk of developing an eating disorder is 50-80% determined by genetics.
- Social factors: Unrealistic pressures to obtain the “perfect” body; the constant influx of images of perfection; and narrow definitions of beauty.
- Psychological factors: Substantial co-morbidity with other mental health disorders — ie., depression, anxiety, obsessive-compulsive disorder, low self-esteem and feelings of lack of control)
- Interpersonal factors: History of abuse; being teased for size or weight; traumatic life event(s); and difficulty expressing feelings and emotions.”
Eating disorders don’t happen overnight. They typically progress slowly, and are often triggered by something seemingly innocent, such as the desire for a child to lose a few pounds, or encouragement to over-train for a sport.
It’s important to note that, while it’s true that eating disorders in children affect the entire family, it isn’t true that parents always cause them to occur.
Early warning signs: What you should be looking for
Children can start to show signs of an eating disorder when they’re still in single digits. These early signs may be missed by parents and professionals, alike.
“One thing parents should do is recognize that eating disorders can start to present in early childhood,” says Elissa Myers, executive director of the Academy for Eating Disorders. “Once your child begins to make choices in the eating arena, parents may be able to see an eating disorder begin to present itself. What is absolutely critical is early diagnosis, intervention and treatment. The best outcomes often occur in children who are diagnosed early,” she explains.
The most obvious sign of a problem — physical appearance — may not be apparent right away. In fact, many children with eating disorders look perfectly healthy. There are, however, warning behaviors that parents can look for.
“Look for a consistent pattern of avoiding food,” suggests Myers. “If you find tons of empty candy wrappers, notice all the food in the fridge disappeared overnight, or if you notice your child in the bathroom throwing up a lot, those may all be reasons for concern. Also, take note of how much time your child spends working out and exercising. If you notice significant weight loss, or significant weight gain, don’t wait — get a professional diagnosis,” she cautions.
Another early warning sign to look for is a lack of weight gain.
“Data indicates that many pediatricians don’t recognize weight loss in a young child as a cause for concern. Parents can help by recognizing that failure to gain weight at a young age is the equivalent of losing weight in an older person. That’s because children are supposed to grow,” explains Leah Dean, executive director emeritus and sitting board member for F.E.A.S.T. Dean urges parents to educate themselves, and their pediatricians, about eating disorders in children. “If a pediatrician sees a dip in a growth chart that’s more than should be expected, that may be a good indication that something is affecting the child’s eating,” she says.
“Weight changes can take a while to show up, but are certainly a red flag,” seconds Dr. Suzanne Dooley-Hash, M.D., assistant professor of emergency medicine at the University of Michigan Medical School, and medical director for the Center for Eating Disorders.
A third — and more readily apparent — warning sign is if there are any dramatic changes in your child’s eating patterns.
“Any sudden, or relatively sudden change in a child’s eating pattern can be a red flag. These include suddenly going vegetarian, or avoiding an entire food group, such as carbs … So are changes in behavior or mood. I’ve seen children as young as 5 complain that they are overweight. That type of concern in a young child can also be a red flag,” says Dooley-Hash.
Seeing the signs: What you can do to help your child
Although it’s important that parents know the warning signs to look for, it’s equally important that parents know the difference between red flags and red herrings. For example, picky eating is one behavior that isn’t typically considered to be a red flag. “Kids go through stages with foods and if you have a picky eater on your hands, you don’t usually need to be concerned. Many kids, for example, refuse to eat vegetables for a while. That’s really common and doesn’t typically present a problem,” says Dooley-Hash explains.
If you’re concerned that your child may have an eating disorder, here’s a list of things that you should do to address the situation – as well as a list of things that you shouldn’t:
How to handle the situation: Dos
- Do trust your instincts if you think something is wrong.
- Do gather facts about your child’s exercise and eating habits to present to your pediatrician.
- Do consult with a medical professional who has a background in eating disorders.
- Do recognize that eating disorders often run in families.
- Do try to figure out what is causing your child’s anxiety about eating.
- Do provide your child with lots of affirmations about themselves that include their body, brain, personality and talents.
- Do let your child know that you love them, no matter what their weight is.
- Do serve healthy meals at home that are filled with lots of vegetables, fruits, fiber, grains and healthy proteins.
- Do pay attention to the level of exposure your child has to models in magazines, very thin characters in animated films, and real-life actors and actresses. Try to balance this out by exposing them to high-profile individuals in many fields who have typical — and realistic — body weights.
- Do let your child know that there are many types of bodies and that beauty and skinniness do not always go together.
How to handle the situation: Don’ts
- Don’t obsess about yours or your partner’s weights.
- Don’t obsess about your child’s weight, even if they are overweight.
- Don’t use the word “fat,” whether it’s in relation to your child or to anyone else.
- Don’t shame your child about their weight, or tell them that they need to lose a few pounds. Choose your words wisely. “Telling your child to take a walk because they are overweight is very different than asking them to take a brisk walk with you,” suggests Myers.
- Don’t dissuade your child from wearing items of clothing (e.g., bathing suits) or encourage them to cover their bodies because of their weight.
- Don’t assume that boys don’t get eating disorders because they do — and in equal numbers to girls, prior to puberty.
- Don’t worry about pre-puberty weight gain in either boys or girls. It’s perfectly normal and is a typical part of every child’s growth curve.
- Don’t vilify any one type of food, including sweets.
- Don’t let your pediatrician talk you out of your concern. Trust your gut — if you’re sure something isn’t quite right, get a second opinion instead.
- Don’t congratulate your child if they lose weight.
- Don’t restrict your child’s caloric intake or put them on a diet. Dieting is a known trigger for eating disorders.
- Don’t encourage your child to lose weight in order to participate in a sport, such as wrestling, gymnastics or ballet.
- Don’t blame yourself, but do empower yourself to advocate for your child.
- Don’t give up. Eating disorders are curable.
We live in a thinness-worshiping culture, and that can make it very hard for parents to figure out what exactly is going on with their child. If you want to be a rock-star advocate for your kid (and you are!), you can’t go it alone. Talk to your child’s doctor, encourage a healthy and affirming lifestyle at home, and reach out to others who may be able to provide support and information. For example, F.E.A.S.T. hosts regular forums where you can find other moms, dads, and child care professionals to talk to. Connect with others, and stay connected to your child. Eating disorders are never an inevitability and don’t need to be a life sentence. Early diagnosis and intervention can make all the difference.
