Fostering a positive relationship with food is a huge parental responsibility from the very start. As soon as solids are introduced, questions of nutrition, allergies or intolerance, and variety loom large, not to mention the worry that comes with having a picky eater.

One dietary concern we often overlook until it becomes a serious problem is disordered eating. Long thought to be illnesses that only affect a small demographic, namely females, contemporary studies confirm that eating disorders may affect girls and boys of any age, race, or background. A recent study from the American Academy of Pediatrics shows the average age for onset of eating disorder symptoms is 12.5.

Eating disorders generally coincide with behavioral health conditions like anxiety and depression. Patients struggling to control their feelings may find comfort in controlling what they eat.

“Physicians at One Pediatrics are consistently addressing the toll of pandemic life on all our patients and especially adolescents,” says Dr. Patrick Hynes at Prospect Pediatrics. “The lack of routine and activity can leave some kids obsessed with food, whether they’re consuming too much or not enough. Social media adds a layer of complexity—we see heavily edited pictures every single day.”

Eating disorders include but are not limited to anorexia nervosa and bulimia nervosa. Anorexia describes a refusal to eat, starving the body of calories and/or over-exercising to lose weight. Bulimia is known as “binging and purging.” Rather than avoiding food, a person with bulimia will eat a large amount in an emotionally-driven “binge,” then “purge,” or forcefully remove the food from their body by means other than natural digestion.

Conversely, binge-eating disorder refers to compulsive over-eating, where patients consume massive amounts of calories without purging or exercising afterward. People who binge often feel guilty afterward but feel unable to control their eating in the moment. You may be familiar with the terms “emotional eating” or “boredom eating,” which imply unhealthy habits not caused by actual hunger.

In 2013, avoidant restrictive food intake disorder (ARFID) also became a defined eating disorder. It refers to limiting food due to concerns other than body image alone, such as extreme “pickiness,” worries about unhealthiness, allergies, or the possibility of feeling sick or choking, or general disinterest in eating. ARFID is challenging to diagnose, but can nonetheless lead to malnutrition or growth concerns.

Listed below are suggestions for addressing food in a healthy way at home:

• Use positive language at home. Many adults struggle with body image and talk about themselves poorly. Describing yourself, a spouse, or even strangers with critical words about appearances can make adolescents think that others are speaking badly about them as well. Adults on weight loss journeys can set a positive tone by valuing their nutritional health first and foremost.
• Encourage every member of the family to participate in meal planning. Kids can look forward to a dinner of their choice, and teens are granted some autonomy in choosing a meal for everyone. You can plan for a balance of healthy options and fun foods alike, which alleviates some anxiety about what to expect for the day or week ahead.
• Try to make eating a matter of routine, not punishment or reward. It’s easy to tempt children with dessert to make them eat their veggies, but habits like this suggest that food is a currency. Adults will often justify “cheat meals” if they’ve exercised or eaten healthy recently, but be careful of encouraging teens to do the same. Food can be enjoyed, of course, but try not to create patterns of “If you do this, you can eat that.”
• If you believe your family member is struggling with an eating disorder, work to express your concerns as a matter of overall health, not a number on a scale. Words like “You look too thin” or “you’re eating too much junk” do not address emotional wellness. Reaching a goal weight is only one part of the recovery process.

Unaddressed, eating disorders can have far-reaching consequences. Long-term malnutrition can wreak havoc on bones, teeth, organs, sleep patterns, energy levels, social relationships, mood, and menstrual cycles in females. Your pediatrician can address symptoms and make recommendations for treating the patient, not the disorder.

For more information, visit the AAP’s dedicated resources for families.