How to identify an eating disorder in teens

Eating disorders are common and can occur in people of any age or gender, meaning teenagers are not immune to developing one. Particularly when they are at this impressionable, comparative and potentially body-conscious stage in their life, it’s important for parents and caregivers to be aware of the types of eating disorders that exist, how they tend to manifest in teens and, importantly, how to get help for loved ones going through this difficult experience.

“Eating disorders are severe mental health conditions related to eating,” said Dr. Katrina Obleada, a pediatric psychologist at Lurie Children’s. “Teens with eating disorders may limit how much food they eat or not eat certain foods at all. Some teens may eat in secret or eat a lot of food at one time. Others may purge after eating or use laxatives to empty their bowels.”

It’s important to remember that some teens who experience eating disorders struggle with their body image, and Obleada says heavy social media use often adds to the pressure kids feel to look a certain way or compare themselves idealized body types. That being said, not all teens with disordered eating habits actively worry about how they look.

The types of eating disorders include:

• Anorexia nervosa: The avoidance of eating altogether or tendency to eat tiny amounts of food, also known as restriction. Teens with this condition may also use excessive exercise or laxatives to try to lose weight.

• Avoidant restrictive food intake disorder (ARFID): Teens with ARFID may limit the amount of food they eat or the kinds of food they eat. Their behavior isn’t typically about body image or weight. Instead, food-avoidant behavior relates to eating habits, such as a history of “picky” eating or negative feelings about food textures.

• Binge eating disorder: Binge eating is when a person eats a much larger amount of food in a shorter period of time than they normally would. During binge eating, the person may feel a loss of control. They often eat when they’re not hungry and often gain weight.

• Bulimia nervosa: Teens with this condition may eat a lot of food at once. After eating, they (purge intentionally vomit) to eliminate the food they’ve consumed.

While anyone can develop an eating disorder, teens experiencing the below scenarios may be at a higher risk.

• Don’t like the way their body looks.

• Have a disciplined or high-achieving personality.

• Have other family members or peers who create rigid rules around diet and exercise.

• Spend a lot of time on social media and compare themselves to idealized images.

Changes in a teenager’s eating habits may be a sign that they’re looking to get “healthier,” but it’s important to look out for when those habits turn into something more dangerous, such as becoming rigid or secretive about eating or making negative comments about their body. Other symptoms or indicators might look like:

• Becoming upset about their own eating behavior or others expecting them to eat.

• Becoming very underweight or gaining a lot of weight.

• Eating quickly or constantly, even when they’re not hungry.

• Experiencing dehydration, dry mouth or changes to tooth enamel.

• Feeling tired or confused.

• Having anxiety or depression.

• No longer having regular menstrual periods.

Obleada notes that these eating disorder signs may mean it’s time to seek treatment. “If you’re not sure where to start, gently and lovingly share that you’ve noticed changes in the way they’re eating, she says. “Listen without judgment.”

Eating disorder treatment varies based on the condition a teen has, what they need, and what they might respond to best. Obleada says it’s recommended that parents speak with their child’s primary care provider to determine if they may benefit from evidence-based outpatient treatments such as Family-based treatment (FBT) — a common approach that helps parents support their child while setting guidelines around eating — cognitive behavioral therapy to address how the teen is thinking about food and their body as well as other mental health conditions, or medication which is also a support to their mental health and ultimately their eating disorder.

As for when disordered eating requires inpatient care, Obleada says it’s when doctors see “significant weight loss and a refusal to eat or drink fluids,” She also notes that heart palpitations, low blood pressure or loss of menstrual periods for a significant amount of time are also clear signs that a teen may need hospitalization.

“Parents have really great instincts, and they know their child,” said Obleada. “Changes in eating habits become problematic when there’s no flexibility. If there’s any rigidity, that’s a clear sign something is going on.”

While you can’t stop anyone from developing an eating disorder, there are protective factors parents can help influence in a teen’s life that help contribute to their mental health. Some include being a body image role model by engaging in positive body talk in the home, setting a healthy example around food and exercise by not feeling guilty about eating certain foods or missing a workout yourself, and keeping open lines of communication with your teen about what they could be going through, especially as it relates to their body image and self-talk.

Dr. Obleada says that if parents do see signs of an eating disorder, they should push for a referral to a specialist and feel empowered to advocate for their child.

For additional information and resources on eating disorders, visit The National Eating Disorders Association (NEDA) (www.nationaleatingdisorders.com) and F.E.A.S.T., an organization for parents and caregivers of loved ones affected by eating disorders.

• Children's health is a continuing series. This column was provided by Ann & Robert H. Lurie Children's Hospital of Chicago.