Eating Disorders – What Should Caregivers Know?

According to Statistics Canada data, approximately one million Canadians meet the diagnostic criteria for an eating disorder (ED).

Eating Disorders are often diagnosed during teenage years as they represent a tumultuous life period for many young people.

The Public Health Agency of Canada says:

Teens who develop eating disorders are showing signs of a personal struggle.”

PHAC also has an incredible resource for parents/caregivers on identifying and responding to suspected eating disorders in teenagers, and I highly recommend any interested parties review that as a compliment to today’s post.

Some of the major warning signs they identify include:

  1. Excessive focus on calories, food and “healthy eating”
  2. Negative self-talk regarding body image, weight and shape
  3. Restriction of food intake ( explicit or hidden) or food avoidance/meal skipping

This brings us to the subject of today’s article, which in fact was written ( under my review, scrutiny & supervision of course!) by my new writing volunteer Mashaal Junaid – a third year nutrition student and aspiring dietitian currently attending Toronto Metropolitan University.

Mashaal thoroughly enjoys the clinical side of nutrition and dietetics and is strongly committed to acquiring and providing high level evidence-based knowledge relating to the role of dietary habits and human health.

When we brainstormed potential topics for our first piece together, and she brought to the table, I knew right away it was as important to do as it was important to do right.

My hope is that we’ve accomplished the latter with today’s piece which highlights important predictors of eating disorder symptoms and offers up important guidance and insights to parents to help ensure a healthy interaction with their teenage children as it relates to food and food intake.

Above and beyond today’s post I once again recommend this exceptional Public Health Agency Of Canada resource as a starting point for all concerned parents.

With that said, let’s get to today’s article – courtesy of Mashaal Junaid.

Risk Factors For Eating Disorder Symptoms

In the introduction to today’s post we identified some of the signs and symptoms of disordered eating in teenagers.

In this section, Mashaal elaborates on those signs and further identifies the characteristics of young people who are at greater risk.

  1. Children with a higher BMI
  2. Children that experienced negative life effects such as sexual abuse
  3. Children that are picky eaters
  4. Children that are showing signs of restricting or eating less than normal
  5. Children that express body dissatisfaction or lower body esteem
  6. Children diagnosed with mental health issues such as anxiety and depression
  7. Children in the 12-13 age group
  8. Children who identify as female
  9. Children who frequently use food for comfort
  10. Children with parents who engage in negative self talk or problematic eating behaviours

Although eating disorders can affect anyone, the indicators above may indicate an increased risk – so what can parents do to help mitigate it?

What Can Parents Do To Reduce Risk?

The goal of this section is to offer up 4 evidence-based strategies for parents who want to create an environment at home that minimizes risk of problematic relationships with food and the issues that may accompany that in their children.

Strategy #1 – Avoid Appearance Related Teasing

Higher self esteem is associated with the reduction of eating disorder prevalence. Self-perceptions are often shaped by their perceptions of what others think of them (Ata et al., 2007). Parents can ensure they promote positive talk about their children’s bodies rather than being critical of it.

There was a strong link found between self esteem being influenced by family and friends in young adolescents (Ata et al., 2007). Appearance related teasing by family members should be avoided as it is linked with negative body image (Atat et al., 2007).

Strategy #2 –Look For Risk Factors, Act On Them

According to The Public Health Agency of Canada:

Eating disorders can be prevented if action is taken at the first signs of recurrent preoccupation with body weight and image

One of the major goals in listing the major risk factors for eating disorders at the start of the article is to provide awareness.

Parents can support their children by listening to children’s concerns when it comes to their mental health and seeking treatment early on if there is due cause because eating disorder  interventions targeted at early stages of illness are considered the most beneficial and critical (Couturier et al., 2020).

Strategy #3 –Promote Autonomy (Independence) Around Food

Give children autonomy and do not use food as a means of control. Parents may be tempted to use foods as a means of disciplining young children but this has proven to have adverse effects on their mental health.

According to this study parents that were overprotective of their children limited their sense of autonomy and this was positively associated with developing eating disorders (Calam et al., 1990)

Eating disorders may be more prevalent in children where mealtimes are the focus of control by the parents (Calam et al., 1990). Parents should use other forms of discipline and allow children to have some autonomy.

Practically, this could look like allowing children more input into the food purchasing and preparation process as well as non-invasively discussing the value nutritious  food has on their life while thinking of ways to implement it in their diets if the children are picky eaters.

It is not scientifically easy or straight forward to draw connections between parenting styles and ED risk, but even a recently published review study from Frontiers In Psychology identified that disordered eating symptoms were associated with parenting styles involving high levels of control.

Strategy #4 –Promote Media Literacy

Body dissatisfaction is highly prevalent in young adolescents especially females (Mclean et al., 2016).

The media is a constant influence in how young adults perceive themselves. In this study young adolescents that were exposed to thin ideals in the media reported higher levels of body dissatisfaction. (Mclean et al., 2016).

Parents should monitor the type of media their children are being exposed to. Media literacy involves the skill of thinking critically about the images seen in the media (Mclean et al., 2016).

Parents can be involved in protective strategies such as talking critically about how images in the media are highly edited and stylised and question their credibility (Mclean et al., 2016).

Future Directions in the Field of Eating Disorders

I’ll be the first to admit that there is a lot of work that remains to be done in the field of eating disorders and nutrition related mental health.

These things go well beyond the realm of individual kids and parents and involve broader societal and cultural obligations.

A recently published piece from the acclaimed JAMA journal highlights some key areas that are lacking and what the future directions need to look like to reduce the prevalence and enhance the treatment of eating disorders in our society.

Let’s see what they found:

  1. Most people remain undiagnosed and untreated due to stigma, feelings of
  2. Training regarding treating disorders is mostly missing from medical curriculums in the US
  3. For some patients with some of these presenting symptoms, primary care clinicians or general psychiatrists might not consider including an eating disorder about underrepresented groups including males, adolescents, Black individuals, Latinx individuals, and LGBTQ individuals
  4. Transgender youth have higher rates of self-reported eating disorders than cisgender heterosexual females.
  5. Funding is needed to support research on screening for eating disorders and its effects on health outcomes.

I hope you found the same value in reading today’s piece as I did researching and writing it.

There is no denying the importance of this subject matter and the work that still needs to be done in this area, but every little bit counts.

Researched and written by Mashaal Junaid with input, review and revisions by Andy De Santis RD MPH

References

Ata, R. N., Ludden, A. B., & Lally, M. M. (2007). The Effects of Gender and Family, Friend, and Media Influences on Eating Behaviors and Body Image During Adolescence. Journal of Youth and Adolescence, 36(8), 1024-1037. https://doi.org/10.1007/s10964-006-9159-x

Calam, R., Waller, G., Slade, P., & Newton, T. (1990). Eating disorders and perceived relationships with parents. International Journal of Eating Disorders, 9(5), 479–485. https://doi.org/10.1002/1098-108X(199009)9:5<479::AID-EAT2260090502>3.0.CO;2-I

Couturier, J., Isserlin, L., Norris, M. et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 8, 4 (2020). https://doi.org/10.1186/s40337-020-0277-8

McLean, S. A., Paxton, S. J., & Wertheim, E. H. (2016). Does Media Literacy Mitigate Risk for Reduced Body Satisfaction Following Exposure to Thin-Ideal Media? Journal of Youth and Adolescence, 45(8), 1678-1695. h ttps://doi.org/10.1007/s10964-016-0440-3

Sawaoka, T., Barnes, R. D., Blomquist, K. K., Masheb, R. M., & Grilo, C. M. (2012). Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology. Comprehensive Psychiatry, 53(6), 740-745.  https://doi.org/10.1016/j.comppsych.2011.10.003

Evans, E. H., Adamson, A. J., Basterfield, L., le Couteur, A., Reilly, J. K., Reilly, J. J., & Parkinson, K. N. (2017). Risk factors for eating disorder symptoms at 12 years of age: A 6-year longitudinal cohort study. Appetite, 108, 12–20. https://doi.org/10.1016/J.APPET.2016.09.005

 

NATIONAL EATING DISORDER INFORMATION CENTRE (NEDIC)
www.nedic.ca

1-866-663-4220
or 416-340-4156 in Toronto
NEDIC provides information and resources about eating disorders, helps individuals find local treatment and

support and offers support through Canada’s only national toll-free helpline. NEDIC holds a national database

of service providers that work with eating disorders