If you ask most parents to describe what they think a teen with an eating disorder looks like, their answers tend to be remarkably similar: A very thin girl, looking down tearfully as she weighs herself on the scale for the fifth time that day.
Of course, some teens with eating disorders are very thin girls who weigh themselves compulsively, and they need and deserve compassionate support.
However, you might be surprised to learn that less than 6% of people with eating disorders are medically diagnosable as “underweight” — and, in fact, the larger your body, the higher your risk of developing an eating disorder.
While awareness of eating disorders more broadly has increased, the representation of what disordered eating looks like still lags dangerously far behind.
And this means, for parents of teens, they’re more often than not missing the crucial signs that could help them intervene on a mental health condition that’s among the most deadly and medically complex.
It’s especially important for parents in particular to be aware and involved, as research indicates that about 95% of eating disorders begin before the age of 25.
As a team of clinicians specializing in adolescent mental health, we’re addressing some of the pervasive and harmful myths that keep parents in the dark, empowering them to intervene with appropriate support sooner rather than later.
1. Healthy eating and exercise are always a good thing for teens.
When parents notice their teen taking an active interest in healthy eating and exercise, it may come as a relief at first.
As parents who care about the health of our families, and understand the role that movement and nutrition can play in supporting our well-being, it can be reassuring when our teen takes the initiative and decides to pursue a healthier lifestyle.
However, many parents aren’t prepared to intervene when a lifestyle crosses the line into something more harmful.
Many of the behaviors that society at large portrays as healthy can easily become disordered, including restricting food intake, cutting out food groups, compensating for food eaten by overexercising, and skipping meals (yes, including breakfast).
This is particularly true for teens, who may not have the self-awareness to notice when their intense regard for healthy eating and exercise has become a detriment to their emotional well-being and overall health.
WHAT PARENTS CAN DO
2. Eating disorders have a “look” and are obvious from the outside.
By far, one of the most concerning myths about eating disorders is that they are visible to an outside observer. The belief that only people in emaciated bodies can have restrictive behaviors, and that only those in larger bodies struggle with binging or eating “too much,” contributes to major misunderstandings about who can have an eating disorder.
The reality is, the majority of teens (and adults) with eating disorders will not be underweight. In fact, teens in larger bodies can still have a restrictive eating disorder, like anorexia nervosa, and therefore may still not be eating enough, regardless of their body size.
One study showed that about 40% of teen girls and 20% of teen boys who are considered “overweight” were using disordered behaviors, and further research has shown that higher weight individuals are more at risk of using unhealthy weight control behaviors than those in smaller bodies.
Which is to say, body size is not an accurate indicator of whether or not someone has an eating disorder. While an eating disorder can impact someone’s weight, their weight alone does not determine the presence or severity of their eating disorder.
WHAT PARENTS CAN DO
3. Eating disorders are a choice — and they’re motivated by insecurity around one’s appearance.
While some eating disorders may have body image concerns as a motivator, not all eating disorders involve a fixation on one’s physical appearance. And regardless of whether or not body image concerns are present, eating disorders are themselves not a choice.
Eating disorders often arise from a complex intersection of biological, cultural, and psychological factors.
But more than that, like many behaviors that exist along the spectrum of self-harm, they are coping mechanisms. An ED may function to numb painful emotions, maintain a sense of agency or control, conform to cultural ideals, and/or cope with circumstances that otherwise feel unmanageable.
It is important to validate that each person’s relationship to food, movement, and their body will be unique and personal, and as such, not assume that someone having an eating disorder automatically means something about their insecurities or emotional experiences.
WHAT PARENTS CAN DO
4. Pursuing weight loss, as long as my teen isn’t underweight, is a good thing.
Teenagers are still developing, and part of that development includes gaining weight. Between ages 13 and 18, most teens will double their weight. This is not inherently cause for alarm, and it’s important to remember that because all teens are growing, that means all teens will need to gain weight to support that growth, whether they are considered average in size or not.
Understandably, in a culture that emphasizes thinness as the norm, some parents are given incorrect guidance that weight gain in teens is more often than not a cause for concern. However, experts say that a teen who isn’t gaining weight or stops doing so abruptly is much more of a red flag, even if that teen was in a larger body to begin with.
Research has shown that among the biggest predictive factors for teens who go on to develop an eating disorder, dieting and other weight control behaviors were some of the most telling.
Especially in a brain that is still developing, engaging in dieting or other restrictive behaviors can not only impact their growth and medical stability, but also their mental and emotional well-being.
While there are ongoing conversations about childhood obesity, those who specialize in working with eating disorders often emphasize that you can encourage health-promoting behaviors without encouraging teens to engage in intentional weight loss, which can be a slippery slope for disordered behaviors.
WHAT PARENTS CAN DO
5. If our family doctor isn’t concerned, there’s nothing to be worried about.
Unfortunately, the level of training a practitioner may have with EDs can vary widely, and this includes medical doctors, nurses, and even some dietitians.
While a family doctor may be well-meaning when they don’t share your concerns, it’s also possible that they hold the same misconceptions about eating disorders that our larger society does, especially in assuming that dramatic weight loss is the most relevant factor in determining whether or not an eating disorder is present.
Weight loss aside, eating disorders themselves are complex, and even standard labs and tests may not medically validate the presence of an ED at first glance.
For example, while many associate anorexia with a lower heart rate (bradycardia), not all patients with anorexia will have a lower heart rate and, in some cases, may experience the inverse (elevated heart rate, or tachycardia) depending on common co-occurring conditions like iron deficiency anemia and dehydration.
Many adult advocates in recovery have shared that it was trusted clinicians that denied the presence of their eating disorder due to weight stigma (or, the bias that negatively impacts patients in larger bodies), resulting in many years of delayed treatment and unnecessary suffering.
You can have a kind and competent family doctor, and it still may not be appropriate to take their assessment as the final word on whether or not a teen has an eating disorder.
WHAT PARENTS CAN DO
At Evolve, we specialize in adolescent mental health, including eating disorders in teens.
Not only do we look at the complex factors at play with eating disorders, our holistic approach is designed to support teens with co-occurring challenges like depression, anxiety, trauma, and more, to ensure the support your teen receives is personalized for their unique situation.
