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Approximately 29 million people in the United States have an eating disorder. Those 29 million people span all ages, ethnicities, body shapes, sizes, cardizem for tachycardia races, and sexual orientations. No one is truly immune to eating disorders — not even kids.

As a parent of two tweens, that’s hard to hear. I want to believe my kids were born with a special protective bubble around them that protects them from all the things, including eating disorders. Unfortunately, I know that just because I want to believe something, that doesn’t make it true. The reality is, we can’t assume our kids aren’t at risk of developing an eating disorder. The reality is that any of our kids could be among those 29 million.

Which means parents need to be prepared. Because when it comes to eating disorders, early detection is key — as is early intervention.

Signs of an Eating Disorder in Children

Eating disorders are generally characterized by a variety of behavioral, physical, and emotional signs, Elizabet Altunkara, Director of Education at the National Eating Disorders Association writes in an email to SheKnows. They include:

  1. An intense fear of gaining weight
  2. Negative or distorted self-image
  3. Preoccupation with food
  4. Hoarding and hiding food
  5. Eating in secret
  6. Social withdrawal
  7. Irritability
  8. Mood swings
  9. Rigidity in behaviors and routines
  10. Noticeable fluctuations in weight
  11. Gastrointestinal complaints
  12. Difficulties concentrating
  13. Sleep problems
  14. Dental problems, and
  15. Impaired immune functioning.

Stephanie Roth, LCSW and owner of Intuitive Psychotherapy NYC, highlighted two additional signs that could signal an eating disorder. The first is a focus on being “healthy” because “when teens start focusing on ‘healthy,’ they often can’t distinguish healthy from thin, so they’ve conceptualized it as needing to lose weight.” The second is a desire to eat different things from friends and family at mealtime, which could be a sign of “frequent secretive eating happening or a lack of eating.”

Not All Eating Disorders Are Created Equal

While eating disorders tend to have a variety of attitudes and behaviors in common, signs of eating disorders can and do vary based on the eating disorder.

Most folks are familiar with anorexia nervosa — a disorder characterized by a fear of weight gain which leads to restricting calories — and bulimia nervosa—a disorder characterized by a cycle of bingeing and “compensatory behaviors” like purging or using laxatives, but those don’t compromise the full spectrum of eating disorders. There’s also binge eating disorder, orthorexia — characterized by a fixation on healthy eating — Avoidant Restrictive Food Intake Disorder (ARFID), Pica, and more.

A child suffering from anorexia is likely restricting their food intake, while a child suffering from bulimia may or may not be cutting out food in front of others, but you may find wrappers in the garbage or food disappearing from the house, says Roth.

When it comes to ARFID, children may begin limiting the range of their preferred foods, notes Altunkara, though not necessarily because they are concerned about their size.

While the range of behaviors makes identifying an eating disorder more complicated, if parents are noticing either significant weight gain or loss, or that their child has a new primary focus on weight loss, diet, and/or controlling food, then it’s time to act.

Once You Recognize the Signs, Seek Help

Parents who find themselves noticing any signs of an eating disorder should seek help immediately.

Altunkara writes that the “presence of any of these signs that your child may be struggling with an eating disorder is cause for serious concern. We recommend seeking professional help at the first sign of an eating disorder.”

Roth echoes that sentiment. “If you suspect someone is developing an eating disorder, it’s helpful to get ahead of it rather than wait until it feels more emergent.” She suggests getting an evaluation from an eating disorder specialist to know whether there’s a true concern. Parents can also involve their child’s pediatrician, who can take blood and monitor weight in a way that appears less threatening because it’s a routine most children are familiar with.

Parents should act even if their child is resistant or adamantly refusing to engage or admit there’s a problem. This is the time to use that parental authority, says Roth, who encourages parents to remember that eating disorders are medical conditions and should be treated as such. Eating disorders are not a phase, nor are they something kids will just “grow out of,” notes Altunkara. They are serious conditions, which, if left untreated during the childhood and teen years, could continue into adulthood.

Break the Silence

“Eating disorders breed in secret,” says Roth, but that doesn’t have to be the case. Parents can break the silence. She urges parents to approach their children and ask questions about how the kid sees themselves and what they’re worried about.

During the discussion, parents should avoid simply telling their children to eat or telling them they’re not fat — which is invalidating. Instead, it’s a good idea for parents to express their concerns and explain any steps they might be taking, whether that’s a doctor’s appointment or a consultation with a specialist, notes Altunkara.

Remember, It’s Not Your Fault … Or Your Child’s Fault

It can be easy for parents to blame themselves, to see an eating disorder as a result of their failure. It’s not. “It’s a failure of the culture,” says Roth, and there’s nothing to be ashamed of.

Eating disorders are “among the deadliest mental illnesses, second only to opioid overdose,” and unfortunately, our kids don’t come in an anti-eating-disorder protective bubble. Until that bubble is invented, the best thing we can do is be present, be aware of any signs, and seek help when we need it.

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