Eating Disorders for Parents: All Guides

Eating Disorders for Parents: General Information

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Eating Disorders Awareness

What are eating disorders?

Eating disorders are complex medical and psychiatric illnesses that affect a person’s physical and emotional health and involve intense emotions and behaviors related to food. These are serious illnesses and can be fatal if left untreated.

There are several types of eating disorders and it’s easy to get them confused because symptoms may overlap. The types include anorexia nervosa, avoidant/restrictive food intake disorder (ARFID), bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (OSFED) which was formerly called “eating disorder not otherwise specified” (EDNOS).

Anorexia Nervosa (pronounced: an–or–rex–e–ah nerve–o–sah) involves food restriction (limiting or not having certain foods or food groups in a person who is significantly low weighted). People with anorexia drastically limit their food intake and have an intense fear of gaining weight, even though they may be underweight or they are losing weight. Anorexia nervosa often presents during early adolescence (11–13 years of age) or during the later high school years (17–18 years of age), when a teen is preparing to go to college, but can occur in people of any age. Someone with anorexia may or may not purge.

Avoidant/Restrictive Food Intake Disorder (ARFID) is a new feeding and eating disorder diagnosis that is given to people who have significant eating problems that lead to consequences such as weight loss, inadequate growth, or a significant nutritional deficiency. Unlike people with other eating disorders such as anorexia nervosa, individuals with ARFID do not have significant body image concerns.

Bulimia Nervosa (pronounced: bull–e–me–ah nerve–o–sah) involves cycles of binge eating followed by a purging behavior. People with bulimia will eat an unusually large amount of food in a short period of time and then purge by vomiting, using laxatives, enemas, or diuretics, or by exercising excessively as a way to counteract the binge and avoid gaining weight.

Binge eating disorder involves eating an unusually large amount of food in a short period of time. People with binge eating disorder feel out of control during these eating episodes and often feel intense shame afterwards. People with binge eating disorder do not purge after binging.

Other specified feeding and eating disorders (OSFED) involve some combination of symptoms of the other eating disorders such as an intense fear of weight gain and preoccupation with food (thinking about food or having food related thoughts most of the day). Atypical anorexia nervosa and purging disorder fall under this category. Many individuals with OSFED have symptoms of the other eating disorders, but may not meet the exact criteria

Disordered eating is a term used to describe the condition when someone doesn’t have all the symptoms of a specific type of eating disorder, but their eating patterns and behaviors put them at risk for developing an eating disorder. For example, extreme dieting can lead to an eating disorder.

Prevalence rates or how often eating disorders occur varies with each disorder. Binge eating disorder and OSFED are more common than anorexia nervosa and bulimia nervosa. Anorexia nervosa occurs in less than 1% of American teens, similar to bulimia, but binge eating disorder occurs in about 2% of teens and OSFED and disordered eating may be as high as 15%.

Myth: Only girls and women have eating disorders.
Truth: Although girls are more likely to have eating disorders than boys, eating disorders do affect males. Males playing sports with weight restrictions such as gymnastics, swimming, rowing, wrestling and track are at higher risk, but can occur in anyone. Guys with eating disorders are often focused on gaining muscle mass, so it might appear that they are simply “getting in shape”.

Eating Disorders for Parents: Causes, Signs and Symptoms

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Eating Disorders Awareness

Causes

There are many theories about what causes eating disorders. There is rarely one cause; most eating disorders are caused by a combination of biological, psychological, and environmental factors and sometimes the cause may not be completely clear.

There are biological reasons that may help to explain why some young people are more likely to develop an eating disorder. Your child may be more likely to have symptoms of an eating disorder if he/she has ever been diagnosed with a mood disorder, anxiety, or depression. Some people with certain traits or temperament and/or family history of eating disorders are at a higher risk of developing anorexia, bulimia, and/or binge eating.

There are psychological reasons that may put a young person at risk such as being diagnosed with obsessive compulsive disorder (OCD), having past or current trauma such as physical, emotional, or sexual abuse, or if a young person feels the need to have more control over some aspect of their life. Personality traits such as perfectionism, extreme desire to succeed, and impulsivity can also play a role. Family values about body size, appearance, feelings about food, how people feel about themselves and their self–worth are important factors as well.

In many modern societies, there is an intense focus on thinness and dieting. Magazines filled with photographs of thin models as well as feature articles that focus on weight loss can be found in just about every grocery store check–out aisle in the United States. Teens might spend hours each day on social media, constantly looking at photos and images for “thinspiration” or other comparisons. Other environmental factors such as participating in sports that place emphasis on body shape and size such as dancing, rowing, gymnastics, track, and wrestling may in some cases influence whether a young person may develop an eating disorder. Finally, stress at school, in sports, with peer groups, or at home, along with cultural attitudes about how a young woman or young man perceives how they should look and behave may play a role. Keep in mind that much more research is needed to understand risks and possible causes.

Signs and Symptoms

You can’t tell whether a person is struggling with an eating disorder just by looking at him or her, but there are often warning signs. Warning signs or “red flags” might suggest that a young person may develop or already has an eating disorder. Below is a list of signs that are linked to some or all types of eating disorders. These signs may also mean that a person has another kind of health condition, so it’s best to talk with your child’s primary care provider (PCP) about your concerns before jumping to any conclusions.

  • Skips meals, makes excuses not to eat, or avoids eating in front of others
  • Over exercises or prioritizes exercise over other previously valued activities
  • Doesn’t eat certain food groups or nutrients (such as carbs or fats) or starts following a vegetarian, vegan, paleo, or other restrictive diet
  • Has unusual behaviors around food such as organizing food, cutting food into small pieces, always finding something wrong with food, or pushing food around
    on the plate
  • Obsessively reads nutrition information or counts calories
  • Constantly weighs themselves or “body checks” (looks at their body in the mirror or feels their body with their hands)
  • Chews gum constantly or drinks large amounts of water, coffee, diet soda, or calorie–free drinks
  • Uses the bathroom after eating or in the middle of meals
  • Consumes unusually large amounts of food at one time
  • Loses control around food
  • Has scars or calluses on hands and knuckles (from using fingers to vomit)
  • Hides food or empty wrappers
  • Diets often or eats mostly diet foods
  • Eats secretively (food may be missing from cabinets at home or disappearing quickly)

If any of these behaviors are a problem for your child, call your health care provider.

Myth: Everyone with an eating disorder is underweight.
Truth: Although people with anorexia nervosa are underweight, individuals suffering from bulimia, binge eating disorder, and OSFED (other specified feeding and eating disorder) can be at a normal weight, or even overweight. Also, people with eating disorders may try and hide their bodies by wearing baggy clothes or dressing differently.

Eating Disorders for Parents: Health Consequences

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Eating Disorders Awareness

A “health consequence” is a general term for the many physical and mental health changes that can result from disordered eating. Some of the dangers may be specific to anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED), while other health problems can be associated with more than one type of eating disorder.

Generally, if food restriction is involved, such as with anorexia nervosa or ARFID, the body is unable to get the nutrients it needs to function properly. In an attempt to conserve energy, the body’s natural response is to slow down. Typical symptoms such as a significant decrease in the heart rate (pulse) and blood pressure are a direct result of this process, and bone density is often compromised, leading to less strong bones.

Purging behaviors associated with bulimia nervosa upset the body’s normal chemical balance. This causes dangerous changes to the levels of electrolytes and subsequently can affect major body organs including the heart. The major risks associated with binge eating disorders may include high blood pressure, high blood cholesterol, heart disease, and diabetes.

The following is an overview of the systems and organs that are affected by eating disorder behaviors. You will note that some of the symptoms and health consequences overlap between AN, BN, and BED. Health consequences of ARFID would be the same as those of AN.

General

  • Marked weight changes
  • Weakness/fatigue
  • Dehydration
  • Abnormal electrolytes (AN, BN)
  • Poor concentration, irritability

Skin, hair, and teeth

  • Dry skin (AN, BN)
  • Brittle nails (AN, BN)
  • Hair loss (AN, BN)
  • Fine downy hair growth (lanugo) (AN)
  • Cold intolerance (AN)
  • Tooth decay (BN)

Psychosocial

  • Depression
  • Anxiety
  • Low self-esteem
  • Over concern with weight/shape
  • Shame or guilt
  • Withdrawal from friends/activities

Endocrine

  • Delayed growth, short stature, delayed puberty, low hormone levels (AN)
  • Delayed onset of menses, loss of periods in females (AN, BN)
  • Abnormal thyroid levels (sick euthyroid)
  • Insulin resistance of Type 2 diabetes (BED)
  • Loss of libido (AN)

Cardiovascular

  • Low pulse (AN, BN)
  • Dizziness (AN, BN)
  • Low blood pressure (AN, BN)
  • High blood pressure (BN, BED)
  • Arrhythmia/irregular heartbeat (AN, BN)

Gastroesophageal

  • Abdominal pain/bloating
  • Constipation
  • Reflux

Musculoskeletal

  • Low bone density, osteopenia, osteoporosis (AN)
  • Stress fractures (AN, BN)
  • Decreased muscle mass (AN)

Eating Disorders for Parents: Helping Your Child Prepare for an Evaluation

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Eating Disorders Awareness

Young people with eating disorder behaviors or symptoms are generally referred to an eating disorder program by their pediatrician, family doctor, nurse practitioner, or physician assistant. As a parent, it’s normal to feel stressed, anxious and even guilty. It’s important to remember that no one is at fault. An eating disorder is an illness that requires treatment and support. For young people with anorexia nervosa, food is the medicine that will get your child back to a healthy weight. For young people with other types of eating disorders, normalizing food–related behaviors is essential to restoring physical and emotional health. While no two programs are exactly the same, outpatient programs usually do a complete evaluation and provide treatment for the patient with an eating disorder in addition to support for family members.

The approach is often multidisciplinary, which means that more than one specially trained health care provider will be involved in your child’s evaluation and treatment plan. Team members may also involve others in your family and will meet to discuss a plan for offering the guidance and support your child will need at home. College students and young adults often see the team alone, but even they frequently work with parents or other family members. Team members in many programs include a registered dietitian and mental health and medical professionals. The roles may vary depending on if the program is family–based, if the treatment team is already in place, the age of the child, severity of the illness, and other factors.

The first visit typically includes the following:

  1. Medical Evaluation by a health care provider who is specialized in caring for children, adolescents and young adults.
    The doctor or nurse practitioner will:

    • Check your child’s blood pressure, pulse, temperature, height and weight
    • Ask about your child’s medical history and growth, as well as his/her family’s medical history
    • Ask for notes and growth charts to be sent for review
    • Ask questions about your child’s eating habits, other behaviors, and physical symptoms
    • Perform a physical exam and order tests which may include blood tests, urinalysis (to see if your child is drinking the right amount of fluids), EKG (a test which looks at the activity of the heart), or bone density test, as needed
  2. Mental Health Evaluation by a licensed therapist experienced in eating disorder treatment. The therapist may have your child fill out a special questionnaire to assess behaviors. Your child and the therapist may talk about:
    • Eating disorder related behaviors
    • Body image
    • The family’s concerns
    • Thoughts and feelings about being evaluated for an eating disorder
    • Treatment goals
    Having your child work with a therapist is an important part of his/her recovery. The therapist can help your child work on his/her body image, self–esteem, and discuss any other emotional issues that may affect their eating habits.
  3. Nutrition Evaluation by a registered dietitian experienced in working with young people with eating disorders and their parents. The dietitian may talk mostly with your child or only with you (if the treatment is family–based) about:
    • Behaviors related to food
    • Health goals and concerns about changing behaviors
    • Food likes and dislikes
    • Common myths about food and eating disorders
    • Creating a healthy eating plan

In a culture obsessed with dieting and body image, it can be challenging to have a healthy relationship with food and exercise. A specially trained dietitian can help you and your child create a personal plan for healthy eating and exercise and discuss harmful myths and confusing messages about food and dieting.

After the evaluation:

Your child’s health care provider or team will talk to you and your child about a treatment plan that will likely include:

  • Which level of care is most appropriate for your child
  • Individual and family therapy
  • Medical monitoring by your child’s primary care provider (PCP)
  • Nutritional support for you and/or your child with a dietitian
  • Other adjunct therapies such as yoga or relaxation exercises
Myth: People choose to have an eating disorder.
Truth: No one chooses to have an eating disorder. Usually a combination of risk factors will lead to a person developing an eating disorder. Recovery involves a lot of time and support from family, friends and eating disorder specialists such as a therapist, dietitian, and medical provider.

Eating Disorders for Parents: Treatment Options

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Eating Disorders Awareness

The Treatment Team

Eating disorders are both medical and psychological conditions. Therefore, treatment usually includes working with a team of specialists including: a medical doctor or nurse practitioner, licensed therapist, a registered dietitian, and sometimes a psychiatrist or family therapist. If your child will be receiving family–based treatment (FBT), the treatment team will include a medical doctor or nurse practitioner and an FBT therapist. A psychiatrist may also be a part of the team.

Medical Specialist

  • Keeps track of your child’s physical health by checking height, weight, blood pressure, pulse, and temperature
  • Orders blood or urinalysis, if necessary, to make sure the body’s chemicals  including “electrolytes” are balanced
  • Orders special tests such as an EKG to monitor heart rhythm, or a bone density test (DXA) to monitor bone health and to see if low bone mass or osteoporosis (thinning of the bones) is present or developing
  • Provides recommendations on weight goals, calcium and vitamin supplements, exercise, hormone replacement (in girls), and medication for anxiety or depression
  • Outlines the best treatment options for your child: The medical specialist may suggest meeting with a therapist and dietitian, starting a family–based treatment program, or having your child go to a day program, the hospital or residential treatment, until medically stable

Therapist

  • Helps your child improve self–esteem, body image, and confidence
  • Involves parents and other family members in providing support, guidance, and supervision of meals
  • Teaches coping skills to help your child manage emotions and stressful situations
  • Addresses other emotional problems that may be related to the eating disorder such as depression, anxiety, obsessive–compulsive disorder, or substance abuse
  • Creates a place where your child can (privately) discuss his or her needs, goals, and understanding of the eating disorder
  • Provides a safe place for your child to talk about feelings such as sadness, anxiety, or anger
  • Discusses disordered eating thinking and behaviors
  • Teaches strategies to help your child become mentally and physically healthy

Family–based Therapist

  • Provides guidance and support around re–feeding your child
  • Teaches you how to manage mealtime conflict
  • Empowers you to restore your child’s weight

Registered Dietitian

  • Helps create a safe and healthy eating plan with your family and child
  • Answers questions about food and nutrition
  • Offers suggestions on healthy eating, weight stabilization, calcium and vitamin supplements, weight goals, and exercise
  • Discusses harmful myths and confusing messages about food and dieting
It’s very important that you and your child meet with a medical provider, therapist, and a dietitian, each of whom has experience working with young people with eating disorders.

Treatment Options

Treatment for an eating disorder is a very individualized process. There are different types and different levels of treatment depending on how medically–stable a person is, how much emotional support they need, the availability of licensed therapists trained in different modalities such as family based therapy (FBT), and what you as a parent think is the best approach for your child.

What to expect at each level of treatment:

Outpatient

Most young people are treated in an outpatient setting. Outpatient treatment is useful for those who are medically stable and are able to maintain their normal daily activities. The two most common approaches are multi–disciplinary and family–based treatment. The choices may vary depending upon the expertise of professionals in your community.

Multi–disciplinary: This type of treatment involves visits with a medical provider, licensed therapist, and registered dietitian. On an outpatient basis, medical providers usually schedule visits for patients who are in treatment for an eating disorder anywhere from once a week to once a month. They will check weight, blood pressure, heart rate, and a urine sample to make sure the patient is drinking enough fluids. Dietitians help by providing information about how much food to eat and what kinds of food are best. They can offer anything from general guidelines to a structured meal plan. Therapists will assist with strategies to help young people avoid restrictive eating, binge eating, and/or purging behaviors.

Family–based treatment (FBT): This type of treatment puts parents and/or family members in charge of the recovery process. Family members control their child’s food and offer support at every meal and snack with guidance from a licensed therapist who specializes in FBT. FBT may be done at home and may involve only the family–based therapist and a medical doctor, but other health professionals may also be involved. The focus of the treatment is on weight restoration and behavioral change. Once weight is restored the therapy will focus on normal adolescent developmental issues.

How do you know if family–based treatment is right for your family?

FBT works best for adolescents who have been diagnosed with anorexia nervosa and who are living at home and who have been sick less than three years. FBT is an intensive family therapy with three phases over a period of 6–12 months and initially involves the entire family in weekly hour long sessions. Over time, families may attend the therapy every other week. The parents are coached in how to help their child eat (and/or stop purging and over–exercising) and parents are empowered to assume responsibility for their child’s recovery.

FBT is a very different approach from traditional therapy and may not be right for everyone or it may not be available in your community. The focus of FBT is restoring weight and eliminating disordered eating behaviors, whereas traditional therapy focuses on understanding why the behaviors develop. In FBT the therapist does not make decisions for the family but serves as an expert consultant; most decisions are left to parents. FBT requires a long term commitment from parents and also requires families to sit with their child during and after every meal.

Whatever treatment is chosen, a strong treatment team and supportive environment is necessary so that your child will be able to restore weight, maintain their goal weight, and return to their life and age–appropriate activities.

Intensive Outpatient Program (IOP)

This type of treatment is for youth either transitioning back into school or work from residential treatment, or for youth who are not ready for or do not require a higher level of treatment. Intensive outpatient treatment usually involves after school group meetings 3–5 days per week for about 3 hours and includes one supervised meal and snack. Someone at this level may or may not also work with an outpatient team.

Partial hospitalization (or day program)

This type of treatment is provided for 6–8 hours during the day and patients go home at night. It includes 2–3 supervised meals and snacks, group and individual therapy. Nutrition education is provided along with various other modalities such as yoga and art therapy.

In–patient

This type of treatment is for people with severe eating disorders who are medically unstable or people who were unsuccessful with treatment at a lower level of care. Patients receive 24–hour hospital care and have a very structured schedule of meals, therapy, and groups. Once medically stable, patients often go to an intensive outpatient program, a residential treatment center, or home with close follow–up.

Residential

This type of treatment is for medically stable patients who need a 24 hour therapeutic environment. Patients live and sleep in a center with others who are struggling with eating disorders. Patients in residential programs have frequent meetings with their team (therapist, dietitian, nurse and/or doctor, and psychiatrist) and various kinds of group meetings. After residential treatment, patients often meet with an outpatient team, or transfer to an intensive outpatient or day program.

Treatment of eating disorders varies from person to person. Some people only receive outpatient treatment, while others may need to transition through some or all levels of care as part of their treatment.

Transitioning

It’s very important to support your child when he/she is transitioning from inpatient or residential to outpatient treatment as this process can be very challenging. Here are some tips to help you make this transition easier for your child:

  • Before your child leaves inpatient or residential treatment, it’s important to set up an outpatient team for regular visits. Ask the treatment team to help you find providers who are experts in eating disorders and who accept your family’s health insurance. Usually an outpatient team consists of a therapist, dietitian, a doctor or nurse practitioner, and often a psychiatrist and a family therapist.
  • Some days will be easier than others. It’s okay and normal for you to have some challenging days with your child.
  • You may be asked to be in charge of your child’s meal plan. Don’t be afraid to seek support from the team, as well as family and friends when necessary, especially around meals. It’s easy to feel overwhelmed if you are supervising the meal plan. Think about one meal at a time, and try not to become discouraged if your child has a hard time once in a while.
  • Encourage your child to be completely honest with their treatment team and to tell them if and when he/she has any thoughts about disordered eating or is using unhealthy behaviors.

Group Support Meetings

This type of meeting is usually held once a week and can be helpful during treatment. There are also group support meetings for parents and/or guardians who are taking care of children or young adults with eating disorders. At group meetings, parents can provide encouragement and can share stories, feelings, accomplishments, and coping methods. Group meetings can usually be found at local health centers, community agencies, or schools. Ask your child’s team about support meetings in your area.

Myth: People with anorexia don’t eat anything.
Truth: Most people with anorexia eat, they just restrict the types and amounts of foods they allow themselves to eat. For example, they may only eat foods that are low in fat or in calories or only eat small portions of food.

Eating Disorders for Parents: Therapy

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Eating Disorders Awareness

Because an eating disorder is both a medical and psychological condition, most people meet with a licensed therapist as part of treatment. Although some families worry about stigma attached to seeing a therapist, it is helpful for parents to encourage their child to keep an open mind because most young people find therapy very helpful.

What are the advantages of having your child see a therapist?

There are a lot of advantages to seeing a therapist and for each person these benefits can be different. A therapist can:

  • Provide a safe place for your child to (privately) share feelings without fear of being judged for causing problems or hurting someone else’s feelings
  • Give your child a place to address other emotional problems that may be related to the eating disorder such as depression, obsessive–compulsive disorder, anxiety or substance abuse
  • Help your child process events in his/her life that may affect mood and can lead to disordered eating or destructive behaviors
  • Help your child figure out what caused the eating disorder, what function/role the eating disorder plays in one’s life, and what factors may have contributed to the use of unhealthy behaviors
  • Help your child examine thoughts that might be distorted, obsessive, or destructive
  • Teach your child healthy coping mechanisms to manage stress and strong emotions
  • Help your child build self–confidence, self–esteem, and positive body image

“It has always been hard for me to open up even to my closest family members and friends. When I finally started opening up in therapy and sharing thoughts and feelings that I had never talked about before, I noticed a huge difference in my mood and how happy I was. Since then, my friends have told me what a huge difference they see in me and how much more open I am. I know this sounds cheesy, but there is no way this would have been possible had I not gone to therapy.” Brooke, 19 yrs.

What are the types of mental health therapy?

Cognitive Behavioral Therapy (CBT): CBT is a type of therapy that teaches your child to understand how thoughts and feelings influence behaviors. CBT helps your child learn to identify and change thoughts that may not be healthy or helpful. CBT is a short term treatment and can also help manage anxiety behaviors.

Dialectical Behavioral Therapy (DBT): DBT is a type of therapy that teaches your child coping skills that are necessary to manage his/her emotions, control and decrease harmful behaviors, and improve interpersonal relationships. It is primarily a group–based therapy with weekly individual therapy. DBT emphasizes skill building and problem solving.

Family–based Therapy (FBT): FBT is a type of therapy that empowers parents to play an active role in helping restore their child’s weight to a normal range. This type of therapy is sometimes referred to as the “Maudsley” method. The therapist meets with the entire family on a weekly basis and supports the parents in feeding their child. Through the process of helping parents solve problems, the parent(s) learn how to support their child through the recovery process. The goal of FBT is weight restoration and returning the child to normal functioning.

Outpatient treatments may include other types of family and group therapy.

Group therapy: Group therapy is a type of therapy that involves your child and others close in age who are experiencing similar struggles. The therapy involves meeting with a therapist as a group to gain support, share experiences, stories, and goals.

Family therapy: Family therapy is a type of therapy that involves your child and some or all other members of your family. The therapy involves meeting with a therapist as a group to discuss family relationships and how the family can best work together to support the recovery of your child.

Helpful tips to support your child make the most use of therapy:

  • Recognize that your child may feel uncomfortable at first. It takes everyone different amounts of time before they begin to feel comfortable opening up to their therapist. If this is your child’s first time seeing a therapist, it is totally normal for her/him to be shy and reserved.
  • Encourage your child to be honest. Therapy gives your child a chance to share how he/she genuinely feels without being judged and without offending anyone. Also, young people with eating disorders often have difficulty seeing their weight loss or disordered eating behaviors as a problem, so the more honest your child is with the therapist, the more helpful therapy will be.
  • Make sure that your child feels comfortable with the therapist. It may take a few sessions for both you and your child to feel that the therapist is a good match. If your child is unable to recognize that they have a problem, it can take longer to feel ready to work on the psychological aspects of their physical health. If the therapist is not a match, help your child find another therapist.
Myth: It’s almost impossible to recover from an eating disorder.
Truth: Complete recovery is possible, but it can take a long time for some people. Recovery can take anywhere from months to years because it requires people to change the way they think and act about food and how they cope. It also takes a team of specialists to address all the issues that led to the eating disorder and is rarely something someone can do without professional help.

Eating Disorders for Parents: Healthy Eating

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Eating Disorders Awareness

Healthy eating is important for everyone’s mind and body. During the recovery process from an eating disorder, your child will usually work with a registered dietitian to normalize eating habits. The goal of healthy eating is to keep your child’s body nourished, energized, and strong. Eating in a healthy way will help your child to concentrate and learn in school, reach and maintain a healthy weight, grow to a maximum height, and stay strong for sports and other physical activities. Healthy eating is not supposed to be a strict diet plan; it is flexible and may differ from person to person. It involves eating regular meals and snacks, along with occasional treats. To eat healthy, your child should eat foods from all of the food groups (carbohydrates, proteins, fruits, vegetables, dairy, and fats) because each group has different benefits.

Carbohydrates: The carbohydrates in foods like grains and starchy vegetables supply the brain and muscles with energy. They help keep our minds sharp and focused and are needed for sports performance.

Dairy: Vitamin D fortified and calcium–rich dairy foods help to keep our bones strong. The protein in dairy foods also helps keep us full between meals.

Fruits/Veggies: These foods contain many important vitamins and minerals, as well as fiber which is needed for normal digestion.

Protein: Protein has many important functions in the body from nourishing hair to repairing and building muscles.

Fats: Fats found in oils (such as canola oil or olive oil), nuts, and fish are great for our heart and skin and provide energy.

Meal Plans: Meal plans are designed to help your child transition back to healthy eating. During treatment, your child may get a meal plan from the registered dietitian that breaks down each meal into servings of food (called “exchanges”) from the different food groups. Each meal should include exchanges from all or most of the food groups, and the number of exchanges that your child needs (from each food group) will be based on his/her nutritional needs. The dietitian will help design meals and snacks based on the exchanges on the meal plan that fit your child’s individual needs. Meal plans are not typically used if the family is participating in family–based therapy (FBT).

Snacks: Healthy snacks give your child energy between meals and will prevent him/her from getting overly hungry. Healthy snacks should be made of two or more food groups. In the sample list of snacks below, you can see how the snack ideas are made from different food groups such as the carbohydrate, fat, dairy, fruit, vegetable, and protein groups.

Sample Snack List

  • Banana with 1 tablespoon of peanut butter (fruit/protein/fat)
  • Grapes and a cheese stick (fruit/dairy/fat)
  • Vanilla yogurt with strawberries (dairy/fruit)
  • Cheese and crackers (dairy/carbohydate/fat)
  • Hummus and baby carrots (protein/vegetable/fat)
  • Nuts and dried fruit (protein/fruit/fat)

Grocery shopping: Ask your child if he/she is comfortable going grocery shopping with you. Your child may be working with a registered dietitian to set goals for trying new foods or reintroducing foods. If going to the grocery store seems stressful for your child, he/she can create a list of foods with the dietitian beforehand. Once your child is more comfortable with grocery shopping, take time to explore the entire grocery store and look for different brands or new foods to try.

Food Journal: A food journal can help your child keep track of what is eaten and any feelings experienced at meal or snack times. Recording this information can help your child tune into his/her body’s hunger/fullness cues which will help to identify areas where more support is needed. Encourage your child to talk to the dietitian about whether keeping a food journal fits into the recovery plan.

Cooking: Planning your child’s meals and snacks ahead of time can minimize the stress during meal preparation. The dietitian can assist with meal planning and brainstorm about ways to give the best support around meals and snacks.

Hunger and Fullness: Eating when we’re hungry and stopping when we’re full helps our bodies balance energy needs and keeps us comfortable. Throughout the recovery process the dietitian can help your child re–learn how to tune into the body’s hunger and fullness cues. Learning to both listen and understand our body’s cues takes time. Using a hunger and fullness scale such as the scale below can help young people better understand their bodies. Hunger, before and after eating is rated, and thus, your child will begin to see a pattern in his/her eating habits. A scale will help your child learn to eat when feeling like a “3” and stop eating when reaching a “7.” If your child is already keeping a food journal, encourage them to talk to a dietitian about whether to include hunger and fullness ratings in the food journal.

Sample Hunger and Fullness Scale:

0 – Starved, feeling faint and weak with hunger

1 – Extremely hungry

2 – Very hungry

3 – Hungry, strong desire to eat

4 – Somewhat hungry

5 – Not hungry nor full

6 – Somewhat full

7 – Full, don’t need to eat more

8 – Very full

9 – Uncomfortably full

10 – Stuffed, painfully full

Myth: Eating disorders are just an extreme form of dieting.
Truth: Unlike dieting, eating disorders aren’t just about losing weight. Eating disorders are psychological problems that may be used as a coping mechanism for issues such as trauma, loss of control, or abusive relationships.

Eating Disorders for Parents: Body Image and Self-Esteem

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Eating Disorders Awareness

Young people are constantly exposed to unrealistic standards in the media such as airbrushed images, skinny models, and overly muscular models, and thus may feel pressure to lose weight or look a certain way. Because of these pressures, many children, teens, and young adults develop poor body image and low self–esteem. Although it’s normal for young people to not feel completely content while their body is constantly changing, it’s important for your child to find ways to feel comfortable with their natural shape and size.

Body image and eating disorders are often perceived to be problems for girls and women, so there is some social stigma for boys and men who are dissatisfied with their bodies or engage in disordered eating behaviors. Generally, males report lower levels of body dissatisfaction than females, which could mean that boys are either more comfortable with their bodies than girls or less likely to admit when they are dissatisfied with how their bodies look. Although some males do report desire to lose weight and to be thin, males who are dissatisfied with their bodies often focus on muscle size, tone and definition, and maintaining low levels of body fat. The risk of eating disorder behaviors such as purging or binge eating are more common in certain sports that require weight restrictions such as wrestling, football, or gymnastics. One stereotype is that only gay males report body dissatisfaction or are at risk for eating disorders. Sexual minority males (for example: gay, bisexual, mostly heterosexual) are at greater risk for reporting some eating disorder behaviors, such as purging. However, sexual minority males may be more comfortable talking about their appearance concerns than heterosexual males and, therefore, may be more likely to seek out treatment. Nevertheless, because most males identify as heterosexual, the overwhelming majority of males who are dissatisfied with their bodies and have eating disorders are heterosexual.

Body distortion or dysmorphia: Body distortion is when people see their body shape, size, and appearance differently from what everyone else sees. Body distortion causes a person to over–focus on flaws or imperfections and feel insecure. Most people who struggle with an eating disorder worry about how they look and what people think of them and have body distortion issues that can be hard to change.

How can I support my child?

  • Buy clothes that your child likes and feels comfortable wearing and give away any clothes that make her/him feel self–conscious or uncomfortable.
  • Suggest relaxing activities such as taking a bath, listening to music, yoga, playing a game, singing, or meditating.
  • Remind your child that everyone’s body is different and that not everyone is meant to be the same shape or size.
  • Encourage your child to spend time with positive people with whom he/she feels completely comfortable around.

The therapist may suggest writing exercises and activities for your child to do, such as:

  • Make a list of accomplishments
  • Write down 10 things he/she likes about himself/herself (caring, responsible, funny, smart, creative etc.)
  • Write down things that he/she can do when feeling healthier (such as running, dancing, hiking, biking, etc.)
  • Write or journal about 5 or more body parts that he/she likes and why (ears, eyes, legs, teeth, hair, etc.)
  • Be critical of advertisements, magazines, and the media. Write a letter to a company if an ad is upsetting or hurtful.
  • Smile when looking in the mirror. It might feel funny at first, but after a while, many people begin to see themselves in a more positive way.
Myth: The media is the cause of all eating disorders.
Truth: The media’s constant focus on dieting, losing weight, being thin, or being muscular can contribute to an unhealthy obsession with food and weight, but whether or not someone develops an eating disorder has a lot to do with other factors too.