How to recognize and treat eating disorders

Dr. Mandakini Sadhir, chief of Adolescent Medicine at Kentucky Children's Hospital, and Mitchell Duross, RD, recently shared information, warning signs and resources for parents who might be concerned that their child is struggling with an eating disorder.

National Eating Disorders Awareness Week is an opportunity to raise awareness about eating disorders and gain a better understanding of prevention and treatment. 

Parents, here is what to pay attention to if you think your child might be struggling with an eating disorder.

Our relationship with food is a spectrum, and each of us faces unique challenges within that relationship. For parents, it is important to be mindful of your own relationship with food and body image and how modeling those behaviors can affect your child. 

If you worry that your child might have a dysfunctional, disordered or destructive relationship with eating, it is crucial to seek professional help. Early detection and treatment are key to successful recovery.

Relationships with food

Four categories are commonly used to describe our relationship with food:

•    Healthy: A healthy relationship is not governed by a rule-based relationship with food. Someone with a healthy relationship welcomes all foods without restrictions and feels in control around food.
•    Dysfunctional: A dysfunctional relationship often sees food only as either good or bad. Self-criticism and self-esteem are factors in this relationship. Someone who is prone to using diets and is concerned about eating the “right” foods may have a dysfunctional relationship with food.
•    Disordered: Disordered eating is a step beyond the dysfunctional diet mentality but not quite destructive. There are severe caloric restrictions around food, and a person might be skipping meals or engaging in reactionary/binge eating, which brings guilt and shame. 
•    Destructive: Destructive eating is the least healthy relationship with food. All thoughts are dominated by food, weight and control. Disordered thoughts and behaviors take up the entire day. Food is no longer nourishing at this stage, and someone in this stage no longer experiences hunger. Someone with destructive eating may experience high levels of anxiety and a sense of numbness. They may be socially isolated, suffering emotionally, and experiencing physical symptoms. 

Warning signs 

Various warning signs can indicate that someone is struggling with disordered or destructive eating. Recognizing these warning signs and intervening early is essential for a quick recovery.

•    Changes in eating habits: Parents may notice their child implementing rules around eating, such as cutting out all sugars and carbohydrates. If your child expresses interest in becoming gluten-free, dairy-free, vegetarian, etc., ask them why they want to, as these can be signs of an eating disorder. Secretive eating and frequently using the restroom after eating can be a sign of binge eating or purging behaviors. 

•    Weight changes: It is important to remain observant of your child's weight if you suspect they may be experiencing disordered or destructive eating behaviors. Children experiencing obesity may be at an increased risk of developing disordered or destructive eating behaviors due to social factors, weight bias and stigma Eating disorders can be challenging to recognize in a child who is overweight because they ordinarily do not look malnourished. However, with the prevalence of eating disorders and obesity rising over the past few years, it is necessary to be mindful of the increased risk. Remember that a large weight loss in a short period is always concerning 

•    Menstrual irregularities: All eating disorders can cause irregular menstrual periods, although those with anorexia nervosa are at a higher risk. Watch out for changes in your child’s periods if you suspect they could be struggling with an eating disorder.

•    Physical complaints: Physical complaints are often what get parents' attention. An eating disorder can increase the risk of developing serious health problems. These health issues can include chest pain, dizziness, lightheadedness, stomach pain, nausea, vomiting, constipation  tiredness, lethargy, poor concentration hair loss, brittle nails, muscle weakness
•    Changes socially: Parents may notice their child’s personality change with them becoming increasingly irritable and isolating themselves socially. Someone struggling with an eating disorder often struggles with low self-esteem and body confidence, which can cause these mood changes.

•    Strict exercise routine: Someone struggling with an eating disorder may also become obsessive regarding exercise. Children with an eating disorder can develop an increased dependency on exercise and may feel like they need to move constantly. 
Support & treatment options
Eating disorder treatment is individualized and can vary depending on the level of care needed.

•    Inpatient/residential: Temporarily live in a treatment facility and receive 24-hour care. 
•    Partial hospitalization program (PHP): Receive care five days a week for most of the day but return home at night. 
•    Intensive outpatient program (IOP): The patient receives treatment multiple times per week. 
•    Day treatment: Structured and usually requires attendance several days a week.
•    Outpatient: Live at home and attend weekly treatment sessions.

If you are concerned about your child, please talk to your provider and discuss referral to UK Adolescent Medicine for further evaluation and assessment of eating behaviors.