Does your child have an eating disorder?

I recently received five emails in four days from mothers who are concerned that their son or daughter may have an eating disorder. That is a sad new record for me.

Let me start by saying that while I am somewhat of an expert by experience, I am not a professional, and the fact that parents turn to me for guidance and advice is a reflection on how uneducated and unenlightened so many pediatricians and family doctors are when it comes to eating disorders. They don’t know how to diagnose them, they don’t have a clear understanding of what eating disorders are (and are not), and they don’t know where to refer patients for treatment. Given that pediatricians and family doctors are supposed to be the front line referring party for eating disorder treatment in Israel, this is truly inexcusable. It’s criminal. It’s reprehensible. It’s no wonder that eating disorder statistics in Israel are through the roof and that our kids are not recovering, when early intervention is one of the predictors of favorable outcomes. All too often, doctors miss the boat on early diagnosis, even when parents bring their child for a visit and state outright “I think that he/she may have an eating disorder.” It is because of this that parents often must advocate to get treatment for their child.

Given this situation, the reality is that it’s up to parents to recognize whether their child has an eating disorder. This can prove tricky, since eating disorders are quite proficient at staying under the radar long enough to become thoroughly entrenched, making diagnosis and recovery that much more difficult. It is for this reason that parents must be super vigilant and listen to their intuition. If you suspect that your child may have an eating disorder, make an appointment to see your child’s doctor alone and explain the behaviors that raised your suspicion. If the doctor trivializes your concerns or seems clueless about eating disorders, find another doctor pronto. Do not “wait it out” or allow someone without the proper competence to treat your child. Eating disorders do not resolve themselves, they get worse with time, and they can be deadly.

Also, make sure that your child is weighed and measured regularly. When my daughter was hospitalized for her eating disorder at age 15, the dietitian asked for her growth charts to determine what her baseline weight was relative to her growth curve before she got sick. We discovered that she hadn’t been weighed or measured since she was 7, so we had no baseline.

Returning to our topic at hand, how do you know if your child has an eating disorder? The first thing that I ask parents is whether they see their child eating. As our kids get older and more independent, they are more on their own during mealtimes. Practically speaking, this means that as parents, we don’t see them eating. We assume that they are eating, but this is not always true. Don’t assume that your child is eating if you are not witnessing it with your own two eyes. A person with an eating disorder will frequently lie when asked whether he/she has eaten, even when they have never, ever lied to you about anything. This is what an eating disorder will do to a person. If your child repeatedly tells you that he/she has “just eaten,” be suspicious. If your child consistently tells you that he/she is not hungry during mealtimes, that’s something to be concerned about. Same thing with frequent stomach discomfort during mealtimes.

Eating behaviors change when someone develops an eating disorder. These changes come in many shapes and sizes. Restriction of any type needs to be carefully evaluated and monitored by parents. Eating disorders hide behind veganism, vegetarianism, gluten intolerance, “clean eating,” and other types of “healthy diets.” If your son or daughter’s food preferences suddenly and dramatically change, that’s a red flag, and something that you need to be attentive to. Supervise what your kids are eating, and make sure that they are getting the right balance of nutrients and the right number of calories for their body type and their activity level. Every eating disorder begins with some type of restriction, so when a mother tells me that her child stopped eating X or only eats Y, my radar goes up.

People with eating disorders sometimes display strange eating behaviors, like cutting food into tiny pieces or using bizarre condiments. They often are reluctant to eat in front of others, skipping family meals or missing social occasions that involve food, many times with a plausible excuse that doesn’t make parents take notice until they see a pattern. If your child stops eating his/her favorite foods and starts characterizing food as “good” and “bad,” sit up a little straighter. Pay attention. Talk about it. Eating disorders love being in the dark. Once you turn on the light, you diminish their presence.

It’s also important to pay attention to how your child is exercising. Is exercise being used as punishment? Is the duration or the intensity of the exercise excessive? Has exercise become an obsession or an addiction of sorts? Don’t let this slide, address this issue with your child; and if necessary, talk to his/her coach or personal trainer as well.

There are other signs that your child may have an eating disorder. Is your child constantly “body checking” (e.g. looking in the mirror, getting on the scale, touching various body parts like wrapping an arm around his/her stomach, pinching body parts)? Are you finding hidden food or empty wrappers? Do you notice your child disappearing to the bathroom after meals?

Certain personalities and groups of people are more likely to develop an eating disorder. Dancers and athletes are two high-risk groups. Overachievers with perfectionistic traits are especially susceptible to anorexia nervosa. People who suffered trauma can develop an eating disorder as a result. Eating disorders run in families, so someone with a first degree relative who suffers from an eating disorder is more at risk.

Eating disorders are treatable illnesses, even if not everyone who has one recovers. The faster you get professional help for your child, the greater the chances are for a full recovery.