Dr. Lucene Wisniewski, Director of the Cleveland Center for Eating Disorders, Dr. Laura Gillespie, Pediatrician in Adolescent Medicine at the Cleveland Clinic’s Children’s Hospital and Dr. Leslie Heinberg, Director of Behavioral Services for the Bariatric and Metabolic Institute at the Cleveland Clinic answer questions from the Your Teen Panel Discussion. (The podcast can be heard at yourteenmag.com) Here are the responses to the audience questions.
Dr. Lucene Wisniewski
My daughter has always been a picky eater and is very thin. How do I know whether she has an eating disorder?
Picky eating can be a risk factor for developing an eating disorder (ED), but most children grow out of picky eating and do not develop an ED. Keep offering your child a wide variety of foods. A non-picky eater might taste a new food 13 times before finding it acceptable. A picky eater might need 113 tastes! Don’t stop offering new foods. Eventually, your child will taste them. You might also consider a consultation with a nutritionist to make sure your picky eater is getting enough vitamins and minerals.
If you are concerned that your child might be developing an ED, review your teen’s growth charts with your pediatrician. A change or deceleration of the growth curve can be an indicator.
How do I have a conversation with my teen who appears to be excessively thin?
You should ask directly. It is certainly fair to start the conversation with, I may be off-base here, and if I am, I apologize in advance. You may be upset with me, but I am willing to take that risk because I care so much about you. Then tell her of your observations and your worries.
What causes eating disorders?
Eating disorders are multi-determined. Causes come from biological, psychological and societal factors. The biological component is that we know EDs are inherited and that there are actual brain and chemical differences between people with and without EDs. There are psychological factors that make people more vulnerable such as perfectionist tendencies, resistance to change, high anxiety and mood problems. Societal factors include the impact of the media, a focus on dieting and the emphasis on good versus bad foods. Each of the three components will have a different influence on a person and each person’s risk for developing an ED will vary.
Can parents prevent eating disorders?
We don’t know the answer to this, but we do know that parents can do things in their house to prevent a vulnerable child from developing bad behaviors. For example, parents can limit their fat talk; they can be good role models around food, eating and body image; and they can take their child to a professional when concerns arise.
If the mom had an eating disorder, can she raise a healthy adolescent?
Get consultation from a professional. We don’t believe that a parent who had an eating disorder causes their child to have an ED, but you may have passed on your biology. Get into treatment and focus on your own recovery.
What resources are there for anorexic patients?
If you are looking for treatment: The Academy for Eating Disorders (www.aedweb.org) has a list of treatment providers worldwide, and is also the premier professional organization for EDs. Other websites that provide information on eating disorders include www.something-fishy.org, www.maudsleyparents.org and http://www.feast-ed.org/
Dr. Laura Gillespie
I have a very thin and active daughter and an overweight son. What should I do?
I would recommend that you focus on healthy eating with all foods in moderation for your whole family and try to de-emphasize the differences in body type. Make it clear to both children that part of your job as their parent is to help them meet their body’s nutritional needs in order to support their growth and health. You can then discuss the different energy needs for each family member based on age, activity and other factors. Be very matter of fact when you mention that the child who is very active in sports will need more caloric intake than the child whose interests are more sedentary. Try to find healthy, fun foods that will be appealing to both but with different calorie densities; for example, strawberry low fat yogurt for your son and strawberry yogurt that has higher calories and fat for your more active child. That will help to eliminate what likely feels like “unfair” differential treatment to your son.
Schools will soon be measuring BMI and weighing students. Won’t this focus more on body size and cause more problems for kids?
This is a potential worry shared by many who work in the field of eating disorders. I think parents and educators alike must view BMI info as only one indicator of health. Also, BMI is only a screen that identifies children with potential risk for obesity or EDs. The data should lead to further communication with the child’s pediatrician who will evaluate this single number in the context of the child’s long-term growth and development.
Are doctors in medical school getting enough quality training to spot potential eating disorders?
This is an area that needs to be examined further. There is a lot of variability in terms of medical school curricula and eating disorder diagnosis and treatment. Those of us in the field, in particular, recognize the importance of this, as eating disorders are often missed and misdiagnosed before coming to our attention. This is very concerning as we know that in the treatment of eating disorders, early diagnosis and treatment is of key importance in order to improve long-term prognosis. This needs to be a focus for future advocacy work.
Who do I call if my kid is an extremely picky eater?
There is obviously a difference between a child who is a picky eater and one with an ED. However, abrupt restriction of certain food groups and dramatic decreases in portion size may signal the beginning of an ED. Because early diagnosis is so important, talking with your pediatrician at the first sign of any disordered eating is a prudent step. If your pediatrician does not feel comfortable with their knowledge base in this area, there are people who specialize in this field who can offer advice and education. Also a nutritionist with a background in the treatment of EDs can be very helpful.
Is there anything you would like to add?
My best advice is to model a healthy relationship with food. Refrain from making negative comments about your body or criticizing other body types. Try not to assign moral qualities and language to food. Food is just food, it is not “good” or “bad.” Join together for family meals and eat them slowly, mindfully and with appreciation.
Dr. Leslie Heinberg
What do I say to my son, who is an emotional and sneaky eater?
Often emotional eating occurs when teens or adults lack healthy skills and strategies to cope with stress, boredom and sadness. Food may be a quick fix but very quickly the emotions return. Discuss alternative strategies, such as exercise, talking with friends and positive self-talk. Also, make sure that you don’t encourage emotional eating by offering food as a reward or a means of dealing with a bad day.
How do I start a conversation with my daughter about what she sees on TV?
Ask her provocative questions about what she sees. Does she know how many people worked on hair and make-up? How many shots were taken with professional lighting? Do you know anyone who really looks like that? See if she can point out media manipulation on her own. Teaching her to look at images with a critical eye is an important part of developing “media literacy.”
Can I have any influence over my teenage son who is very overweight?
Unfortunately as teens get older they have much more freedom over their food choices. Try not to set up a power struggle over food–you’ll lose. Instead, focus on moderation in your own home. Focus on increasing family activity and decreasing the battle over food in the home.
How can we encourage adults to stop focusing on good food vs. bad food and body size?
Model the language you want to use, for example, “Food isn’t good or bad! There are just foods to eat everyday and foods to eat once in awhile,” or “I’m trying to see how long I can go without ‘fat talk’. I’m really noticing that it helps me feel better.”
My son seems to be a binge eater and wants to buy unhealthy school lunches because his friends are eating school lunches. What should I do?
Binge eating is an eating disorder that can make weight management much more difficult. If you feel your son truly eats a very large amount of food in a short period of time and feels out of control, you should speak to his physician about a referral to an eating disorders specialist. His desire to buy lunch is a separate issue. You can review the menu online and suggest better choices.
Is there anything else you would like to tell parents?
Parents should discourage weight loss diets for overweight younger teens. The healthier goal is weight maintenance while they are still growing.