Eating habits often change during adolescence. Teenagers may become more independent about what they eat, experiment with different styles of eating or become more interested in nutrition, exercise and their appearance – but sometimes those changes signal something more.
Eating disorders are becoming increasingly common, particularly among adolescents and young adults. Rates were already rising before the COVID-19 pandemic and increased more rapidly during and after the pandemic. WashU Medicine specialists continue to see high numbers of young people affected by eating disorders.
Recognizing an eating disorder early is important. These conditions affect much more than eating. They can have serious effects on both physical and mental health, which is why collaboration across specialties is an important part of treatment.
WashU Medicine adolescent medicine and child psychiatry specialists work together to address both sides of eating disorder care, including a new program designed to streamline access to family-based treatment for adolescents ages 12 to 19.
Who can develop an eating disorder?
Eating disorders occur across ages, genders, socioeconomic backgrounds and other demographics. Although many eating disorders first emerge during adolescence and young adulthood, making assumptions about who is at risk can cause symptoms to be overlooked.
Eating disorders are also complex. Genetic, cultural and social factors can all contribute to their development. Because adolescence naturally brings changes in eating habits, independence and body awareness, it can sometimes be difficult for parents to distinguish typical behavior from an emerging problem.
What are the warning signs of an eating disorder in teens?
A teenager deciding to eat differently or becoming interested in fitness does not necessarily mean they have an eating disorder; however, parents should pay attention when these changes become increasingly rigid or begin affecting other areas of their child’s life.
Signs that an evaluation is needed may include:
- Weight loss, failure to follow an expected growth curve or unexplained rapid weight gain
- Increasing preoccupation with calories, dieting, food or “macros”
- Eliminating entire food groups or becoming progressively more selective about foods
- Avoiding eating around other people, hiding food or eating in secret
- Excessive exercise or difficulty taking rest days
- Frequent weighing or significant changes in clothing choices, such as suddenly wearing oversized clothing
- Withdrawal from friends, family or previously enjoyed activities
- Physical symptoms such as fatigue, dizziness, fainting, hair loss or irregular menstrual periods
- Purging or using diet pills, laxatives or diuretics
Eating disorders can also change how a person perceives their own behaviors. What is concerning to a parent or medical provider may feel normal to the adolescent experiencing it. Early detection and treatment provide the best chance for full recovery.
What does treatment look like for eating disorders?
Eating disorders affect both physical and mental health. That makes multidisciplinary care especially important.
Adolescent medicine specialists evaluate and diagnose eating disorders, monitor growth and physical health and look for medical complications or other possible causes of weight loss. Psychiatrists address the mental health component of an eating disorder, including co-occurring conditions and the thoughts and behaviors that can make recovery difficult. Depending on an individual patient’s needs, treatment may involve therapy, medication, nutritional support and other interventions.
The goal is not simply to address one symptom. For restrictive eating disorders in particular, restoring healthy nutrition is essential because malnutrition itself can reinforce restrictive behaviors and obsessive thoughts about food.
If a patient becomes medically unstable, hospitalization may be necessary. Once the patient is medically stable, the care team can determine whether outpatient family-based treatment, residential treatment or another approach is most appropriate.
What is family-based treatment for eating disorders?
For children and adolescents, one of the most evidence-based approaches to eating disorder care is family-based treatment (FBT). Rather than expecting an adolescent to manage recovery alone, FBT gives parents and caregivers an active role.
Treatment generally progresses through three phases. Initially, caregivers take responsibility for food and eating while the child is renourished. As recovery progresses, control over eating is gradually returned to the adolescent. The final phase focuses on helping the young person return to everyday adolescent life and helping the family move beyond a relationship centered around the eating disorder.
“Parents, you fed your child their whole life. Don’t let this eating disorder take away your skills as a parent,” says Callie Bishop, MD, a WashU Medicine child and adolescent psychiatrist. “Let’s utilize your skills and get this back on track.”
How can parents support a healthy relationship with food and body image?
Parents cannot necessarily prevent an eating disorder, but the way families talk about food and bodies can help create a healthier environment. Sarah Garwood, MD, a WashU Medicine adolescent medicine specialist, recommends focusing conversations on what the body can do rather than how it looks. Parents can also be mindful of how they talk about their own bodies and avoid assigning moral value to food by describing foods as “good” or “bad.” This can unintentionally create shame or guilt around normal experiences such as having ice cream with friends.
For adolescents already experiencing disordered eating, returning to regular eating is one of the first steps toward recovery. Consistent meals and snacks, supportive family involvement and avoiding discussions about calories, weight and body size can all be part of that process under the guidance of the child’s care team.
When should parents seek help for an eating disorder?
If you are concerned about changes in your child’s eating habits, weight, exercise patterns, mood or behavior, you do not have to navigate alone. Talk privately with your child about what you have noticed and schedule an evaluation with a medical provider. Individuals with eating disorders may not recognize their own thoughts or behaviors as concerning, making outside support particularly important. Early evaluation also allows providers to assess both physical and mental health and determine what level of treatment may be appropriate.
Eating disorder treatment at WashU Medicine
Eating disorders can affect physical health, mental health, nutrition, development and family life. Addressing those needs often requires more than one type of specialist.
WashU Medicine specialists in adolescent medicine and child psychiatry work together to evaluate and treat eating disorders in children and adolescents. Treatment is individualized based on each patient’s medical, nutritional and mental health needs. Click here to schedule an appointment with one of our specialists: Eating disorder treatment at WashU Medicine