Eating Disorders: Is Your Child at Risk?

Washington Parent Magazine, March 2003
Kay Kosak Abrams, Ph.D.

Last year, a 12-year-old boy who was anorexic came to me for treatment. He told me that he learned from his health class that "fats were bad." So, being inclined toward perfectionism, he began to read food labels in order to eliminate fat from his diet. Because he was an athletic child with good metabolism, his appetite and weight quickly diminished.

A 19-year-old patient, began restricting her eating as a sophomore in high school. She was the "perfect" child, with superior grades, talent in the arts and success as a competitive runner. After two or three years of starving herself, she endured two or three years of stormy bingeing and purging. As her eating disorder became all-consuming, she lost herself and her friends. It has taken her another three years to recover.
Panicked about her daughter's high cholesterol, a mother gets rid of all foods with fats. She reacts with enormous emotion when she catches her daughter, who is 6 years old, eating a forbidden food. The daughter begins dreaming about food, hoarding food and overeating. She craves sweets "all the time."

A 12-year-old tells me she is a vegetarian. She refuses to eat animal products, because this makes her feel better. She also tells me that "no one eats a sandwich, chips, fruit and milk…not in middle school! Lots of girls think they are 'fat.' "A mother consults with me because she has spent her lifetime battling her weight. She makes a "career out of what goes in my mouth." She has closets full of different size clothing to accommodate weight gain or loss. She does not want her daughters to have the same lifetime of self-loathing. And she wants to be free from feeling enslaved by this obsession with weight and size.

As a psychologist who specializes in eating disorders, I visit schools to talk to students. Some high school girls skip breakfast, snack mid-morning, skip lunch and "pig out" when they get home from school. They do not join their families for dinner because they have "too much to do."

Although our society supports a profound fear of body fat and a drive for thinness, Americans are getting fatter and fatter. Our children are growing up with easy access to gratifying snack foods and portions that promote the message that "bigger is better." At the same time we are more sedentary, family meals are rare and a prepubescent thin is "in."

We are unlikely to eliminate our natural biological attraction to "beauty," as featured in the media, nor can we eliminate either the snack food industry or our obsession to find the "right" way to eat to avoid illness! So, how can we parents raise our children to be "normal" eaters in a society that primes us all to have eating disorders?

The Risk Factors

Developmental and biological vulnerabilities underlie eating disorders. Developmentally, the high-risk factors include pre-puberty, puberty and leaving home for college. These developmental stages correspond with physical changes. Many children put on pre-puberty weight, which is literally a layer of baby fat. This weight gain may begin around age 9 and last as long as age 14 or 15. Many doctors and parents react to this weight gain by putting the child on a diet. Unfortunately, most diets are restrictive psychologically or physically and therefore result in compensatory overeating.

A second growth spurt occurs in late adolescence just prior to leaving home. This is when young girls change from looking like teens to looking like grown women with child-bearing capacity. Many young girls want to hold on to their junior-size thighs -- thus the efforts to control food intake.

Biologically, one of the greatest risk factors for developing a severe eating disorder is a mood disorder, predominantly anxiety. When we experience anxiety in the form of perfectionism or mood cycles, adhering to rules about diet yield a sense of control and comfort. So the true underlying cause of a severe eating disorder is often anxiety. On the outside, the problem appears to be about weight and body dissatisfaction. The real problems that are interfering with maturity may involve a sense of belonging and self-confidence.

The Importance of Appetite Controls

When we were young, we knew hunger. We ran outside for hours until the dinner bell rang. When it rang, we recognized that we were ready to eat dinner. Many people today place more trust in the commands of diet books than in their own body signals. Hunger and fullness signals are the keys to regulating eating. In today's fast-paced life, many families have lost their mealtime rituals and, along with losing those rituals, comes a loss of awareness about what our bodies need. We raise our children today as if we are afraid of hunger. We feed our children snacks in the car and juice boxes when they are thirsty, throughout the day. By the time they sit down to a meal, they may not feel hungry. Their hunger and satiation signals become confused. Maybe their tanks are never quite empty and never quite full. Moreover, we may dish out processed foods too often because we're "on the go!" Then we wonder why our children cannot sit through a meal calmly!

Restrictive or irregular eating patterns result in metabolic malfunctioning. It is no different than abusing your car by ignoring needs for refueling or tune-ups. Restricting food results in quick weight loss, which is naturally reinforcing. What comes next is a craving for sweets and carbohydrates. If you were living at a time of "feast or famine," your body would be doing you a favor by increasing cravings for foods that are easily stored away as fat deposits. After starving, it is beneficial to have no fullness signals so you can gorge, so to speak, before the next famine. Essentially, our dieting culture has trained our bodies to lower metabolism and preserve weight. After years of chronic yo-yo dieting, the body becomes even more adept at storing fat reserves in preparation for the next period of restricting!

Take the Time to Truly Nourish and Refuel

There is nothing so satisfying as a meal when we are truly ready to nourish ourselves. Recreate mealtimes that are sacred and special. Make sure that the foods you eat are satisfying, so that fullness signals in the brain turn on. When you eat satiating foods, such as peanut butter on celery, cheese and toast, fruits and granola with milk or guacamole, you are truly satisfied, and compulsive cravings go away. Model the ability to stop when you are full and to top off a meal with a sweet without overindulging.

Unless a child is crying with hunger, do not be afraid to wait for meals. Food does not need to be handed out on a whim or in response to boredom. Do not confuse boredom, restlessness or other emotional needs with hunger. Don't provide open pantries that are a free-for-all "24/7." Many snack foods increase false appetites because they are saturated with salts and sugars.

In addition to the overabundance of snack foods, Americans are getting fatter while consuming nonfat foods because nonfat foods are not satiating, and cravings are constant and chronic. Compensatory eating binges are the body's way of fighting b

Throw out your Scales and Diet Books

Children learn their attitudes about food and their bodies not only from the media but also from adults. When parents diet, so do children. We have been taught to measure our worth by a number on a scale. Measurements of food or body-size or calories burned undermine our ability to trust our own signals about what we need. We should be mindful of our irrational belief systems and our wish for quick answers when it comes to health. Illness and even heart disease strike individuals of different sizes and backgrounds. Childhood cholesterol levels may not remain high. Many of our grandparents ate roast beef and gravy and lived long full lives without running three miles a day and popping vitamins. We do not have all the answers yet; it is far too simplistic and dangerous to go on the favorite "diet of the year." If diets worked, we would not have a forty billion dollar diet industry that capitalizes on failure.

Teach Moderation and Live an Active Lifestyle

Along with ritualizing mealtime, teach moderation for the foods that are "addictive," such as many junk, foods. Allow moderate portions of snacks and sweets because our children will seek and find them. It is our job to teach this moderation. Love of food and body is a better way to go than self-demeaning criticism and restricting. Be active in a fun-loving and natural way rather than approaching regimented exercise that promotes an "I need to work out because I pigged out" mentality. We move around in an aerobics class to feel good not to anticipate bikini season or that piece of cake you want to eat tonight, which provokes anxiety, judgment and guilt.

Movement and activity are easy for naturally athletic folks, but some of us will have to work hard to find more inviting activities to overcome our natural inclination to sit back. If you feel inclined or obliged to be more active, find natural, frequent ways to be active. Walk the dog, and have the kids do the same. Rake leaves with your children, even if they throw a fit, so they will learn the good feeling of physical accomplishment. Walk to the nearest market. Go on a family hike. Use your bikes to get around. Put on music, and dance while you clean the house together. Go for an evening walk after a full meal.

Love Each Other from the Inside-out

We can enjoy the beautiful people in Hollywood even while teaching our children the difference between fantasy and reality. We can take the opportunity to teach morality when our young ones are faced with fast fashion and lustful commercialism. We can model humor about the discrepancy between real relationships and romance novels. We can make sure that we have discussions and commentary in the home so that media messages and fashion magazines are not a stronger influence than family values and moral teachings.

There is a high incidence of restrictive eating disorders among models, actors, physical trainers, ballet dancers, competitive wrestlers and gymnasts as they try to mold their bodies into a "glass slipper" of a happy-ever-after ideal in order to win. There is a price to pay for pursuing perfectionist goals that require all-or-nothing thinking, which can be all-consuming and even alienating. It takes a strong psychological constitution to pursue such goals and recognize the sacrifice involved in order to adjust to life and relationships outside of that pursued ideal.

One of my favorite quotes comes to mind when I am trying to "de-indoctrinate" a dieting guru who maintains an all-or-nothing standard of thinking, "At first, the truth will aggravate you but then it sets you free." Disordered eating behaviors are rarely about weight. Eat real meals regularly. Eat foods that are satiating and satisfying. Practice trusting your body's hunger signals. Make mealtimes sacred and take the time to sit with others and relax. Be active. Popular temporary absolutes about weight and "health" are often enslaving, not liberating. As a diverse society, we must stop defining a "right" way when it comes to weight regulation strategies, definitions of attraction and idealistic pursuits of eternal youth and health. In the meantime, help your family slow down to nourish, rather than punish, both emotionally and physically.

Copyright 2003 - Dr. Kay Abrams

Kay Kosak Abrams is a clinical psychologist with expertise in treating eating disorders in teenagers and young adults. In addition to publishing research in the area of ethnicity and eating disorders, she created a workshop entitled, "Rediscover Eating," to help chronic dieters and overeaters. Join Dr. Abrams for her talk on this subject, sponsored by Washington Parent magazine, and have your questions answered on Monday March 17 at 8 p.m., at the DoubleTree Hotel in Rockville. To register call 301-949-2098.

Eating Disorder Resources


The Gurze Eating Disorder Resource Catalogue from

Extensive online information and recovery support for individuals and loved ones:

The National Eating Disorder Association:

The National Association of Anorexia Nervosa & Associated Disorders:

The National Association to Advance Fat Acceptance, Inc., an advocacy group:

Overeaters Anonymous, a 12-step self-help fellowship:


Preventing Childhood Eating Problems, by Jane Hirschmann, C.S.W.

Perfectionism: What's Bad About Being so Good, by Miriam Adderholdt-Elliot, Ph.D.

Girl Power in the Mirror, by Helen Cordes

Intuitive Eating: A Recovery Book for the Chronic Dieter, by Evelyn Tribole, M.S., R.D.

Mom, I Feel Fat! Becoming Your Daughter's Ally in Developing a Healthy Body Image, by Sharon Hersh

Am I Fat? Helping Children Accept Differences in Body Size, by Joanne Ikeda, M.A., R.D.

Preventing Disordered Eating: A Manual to Promote Best Practices for Working with Children, Youth, Families and Communities, ED Resource Center of British Columbia

Surviving an Eating Disorder: Strategies for Family and Friends, by Michele Siegel, Ph.D. and Judith Brisman, Ph.D.