Eating Disorders Prevention: Help for Parents

A Family Guide to Eating Disorders, Part 1: Prevention

How much should you worry if your teenager starts to claim she's not hungry, eliminates foods from her diet, or expresses worry about becoming fat? When does "fussy" or diet-like eating go too far? How can you tell if a person you care about has an eating disorder, and what can you do if you suspect that she does? These are scary questions for parents and concerned others to confront. There is, indeed, a norm in our society that encourages people to value thinness, to diet even when unnecessary, and to be concerned about body size and shape. Under these circumstances, it may be hard to tell what is normal and what is not.

The warning signs of eating disorders can be easily listed, and will be outlined in Part 2 of this Guide. An equally important concern, however, is how to help young people avoid eating problems in the first place.

Self-Esteem is Essential

People who grow up with a strong sense of self-esteem are at much lower risk for developing eating disorders. Children who have been supported in feeling good about themselves - whether their accomplishments are great or small -- are less likely to express whatever dissatisfactions they might experience through dangerous eating behaviors.

And yet, while parents can contribute a great deal to building children's resilience and self-confidence, they do not have complete control over the development of these disorders. Some children are genetically vulnerable to depression or other mood problems, for example, which can affect feelings about self. Some become stressed and self-blaming as parents divorce or fight, despite adult efforts to protect their children from the harmful effects of parental discord. School and peers present stresses and pressures that can wear kids down. So, all parents can do is their best; it is not helpful to blame yourself if your child does develop eating problems. Parents can, however, try to communicate to their children that they are valued no matter what. They can try to listen to and validate their children's thoughts, ideas, and concerns, even if they are not always easy to hear. They can encourage outlets for children where self-confidence can build naturally, such as sports or music. It is critical, however, that these outlets are ones in which your child has genuine interest and experiences enjoyment; pushing a child to excel in an area in which her talents or interests do not lie can do more harm than good!

Role Models, Not Fashion Models

The parents' own attitudes and behaviors around eating, food, and body appearance can also serve to prevent eating disorders in children. Many children today witness dieting, compulsive exercise, body dissatisfaction and hatred modeled by parents. Also, well-meaning parents often express concern when children show natural gusto for eating fun or high-fat foods, or when they go through perfectly natural stages that involve some chubbiness. Parents ideally should model a healthy approach toward eating: eating, for the most part, nutritious foods (and not in a sparse or constantly diet-like manner); and fully enjoying occasional treats and social events that involve food. They should model a healthy cynicism toward media images of impossibly thin people and acceptance of a full range of body types. This is challenging, given how much we all are pulled these days by powerful media and outside pressures to be sizes we cannot comfortably be. I suggest families rent Slim Hopes: Advertising & the Obsession with Thinness (Media Education Foundation, 1995, 30 minutes), an excellent and powerful video by media expert Jean Kilbourne. Watch it together and talk about it; this is a useful exercise for boy as well as girl children and their parents, and probably merits repeating as children grow and develop.

In Part 2 of this Guide, we will focus on identifying eating disorders and getting help for the sufferer and for her family.

A Family Guide to Eating Disorders, Part 2: Identification and Treatment

In Part I of this Guide, we focused on strategies for preventing the development of eating disorders in children. In Part 2, we will turn to the warning signs of eating disorders, how to get help, and some Internet resources for families in need.

Signs and Symptoms of Eating Disorders

Here are lists of some of the "red flags" you might notice with eating disorders.

Anorexia Nervosa:

• Weight loss;
• Loss of menstruation;
• Dieting with great determination, even when not overweight;
• "Fussy" eating -- avoiding all fat, or all animal products, or all sweets, etc.;
• Avoiding social functions that involve food;
• Claiming to "feel fat" when overweight is not a reality;
• Preoccupation with food, calories, nutrition, and/or cooking;
• Denial of hunger;
• Excessive exercising, being overly active;
• Frequent weighing; "Strange" food-related behaviors;
• Complaints of feeling bloated or nauseated when eating normal amounts;
• Intermittent episodes of binge eating;
• Wearing baggy clothes to hide weight loss; and
• Depression, irritability, compulsive behaviors, and/or poor sleep.

Bulimia Nervosa:

• Great concern about weight;
• Dieting followed by eating binges;
• Frequent overeating, especially when distressed;
• Binging on high calorie salty or sweet foods;
• Guilt or shame about eating;
• Using laxatives and/or vomiting and/or excessive exercising to control weight;
• Going to the bathroom immediately after meals (to vomit);
• Disappearing after meals;
• Secretiveness about binging and/or purging;
• Feeling out of control;
• Depression, irritability, anxiety; and
• Other "binge" behaviors (involving, for example, drinking, shopping, or sex). Getting Help

Many parents or concerned others do not know how to approach a person they're worried about and getting them the help they may need. People can feel very helpless, scared, and, at times, angry when someone they love develops an eating disorder. Help is available, however, and many people and families can grow stronger as a result of seeking help.

If you notice several "red flags," tell the person displaying these behaviors that you are concerned about what you have observed. People with more restrictive (or anorexic) symptoms are much more likely to deny a problem and to resist suggestions that they eat more or see a therapist. The restriction may actually be making them feel "good" in a way, and they may be terrified of losing the "control" they feel they've begun to achieve. It can be helpful to provide information and educational materials, or to suggest that the person see a nutritionist for a consultation.

If denial of the problem persists, and the restricting behavior continues or worsens, younger people may have to be told that they need to see someone for help. They can be given choices: whether they are more comfortable seeing a female or male therapist, for example, or whether they prefer to go alone or with family. With older family members, intervention may not be so simple. In these cases, it may be like dealing with someone who has a drinking problem: you can repeatedly remind the person of your concern and encourage help, you can get help for yourself, but you may not be able to "make" that person change. If you are concerned about imminent dangers to health (as when a person has lost a great deal of weight and looks unwell), bringing a person to a doctor or even a hospital emergency room for evaluation is appropriate.

Individuals who binge and purge are often very distressed about what they are doing and may be afraid of confronting the problem (for example, they may be afraid that they will get fat if they stop purging). They are, however, somewhat more likely to agree to explore options for getting help. In that case, getting educational materials, therapist referral lists, and information about groups can be helpful. It is important to stay as non-judgmental as possible, even if you feel that the person's behavior is "disgusting" or strange.

People are sometimes reluctant to talk to a therapist or counselor. If they are more comfortable starting with a doctor or nutritionist, that's at least a first step. It can be useful, though, to make sure the person understands that feelings, relationship issues, and self-esteem are almost always involved to some extent in these situations and should not be ignored, no matter what course of action the person decides to initially pursue.

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