Eating disorders (EDs) — including binge eating, anorexia, bulimia and acute refusal food intake disorder (ARFID) — affect 28 million Americans, with those aged 12 through 25 making up 95% of cases. EDs affect children and teens both physically and mentally and can be challenging to address for parents and caregivers. Anisha Abraham, MD, MPH, acting chief of the Division of Adolescent and Young Adult Medicine, and director of the Donald Delaney Eating Disorders Clinic, answers common questions parents have about how to best support adolescents with eating disorders.

How do I support an adolescent dealing with an eating disorder?

Communication is key. Ask them how they are feeling about their body image and what they see when they look in the mirror. Ask if peers or friends are worried about their body image or if there are social media sites that are influencing their perception. Ask specific questions about what might be happening and listen to them when they answer.

Is my adolescent’s eating disorder diagnosis my fault?

The development of an ED is not anyone’s fault. Numerous factors can contribute to a young person developing eating-related or body image issues. This can include, but is not limited to, the media they are consuming, the activities they participate in, the COVID-19 pandemic, genetic history, etc.

Is it okay to talk about my adolescent’s diagnosis to others? Who can I look to, to support them?

ED recovery is very individualized in terms of who needs to know about a diagnosis. For some young people, it can be difficult for peers or even family members to find out they are struggling. If this is the case, it would be best — and a great way to establish and maintain trust in this matter — to keep their diagnosis and journey to recovery confidential. As far as seeking help, we encourage using a multidisciplinary team to support young people who are struggling and address issues from all angles. This can include pediatricians, coaches, nutritionists and psychologists.

How can I help my adolescent work on their relationship with food?

It is not easy changing a teen’s relationship with food, their body or exercise. The short answer is to ensure they know they need a variety of food and nutrients in their bodies as they go through puberty. That includes eating carbohydrates (carbs), proteins, fats, fruits and vegetables. When young people start to restrict their caloric intake or eat a lot of foods without much nutritional value at once, they are not getting that balance, which can affect their ability to think and  their overall wellness and keep them from doing the things they want to.

The key is ensuring they have a healthy and positive relationship with food, and that can start with you. If there is anything parents and caregivers should take away, is to be conscious of how you speak about food. Speaking of food in categories of “good” and “bad” further perpetuates the idea that people should restrict. Rather, speak about food as a source of fuel and nutrients, and ensure you are modeling a healthy relationship with food and body image.

Another way to support teens is by giving them options for food. Oftentimes EDs develop from a lack of control; if a young person feels like they have no control in other parts of their life, food is often what they turn to, to have control. By giving them options, you still allow them to make their own food decisions while ensuring they get the proper nutrients. If challenges persist, it is best to consult with a health professional.

Can my adolescent’s eating disorder affect the household?

An ED can affect the entire household. By knowing and being aware of this, caregivers can work to develop a family-based approach. While this is based on everyone’s comfort level, you can involve the whole family in things like therapy and holding space for conversations around food, self-confidence and self-perception. Again, children as young as 7 years old are developing EDs, so it is never too early to support the development of positive thinking patterns and relationships between food and bodies.

How can I handle people making comments about my adolescent’s appearance?

In our society, people make comments all the time about appearance and size, and it is particularly important to refrain from making comments when we talk about a young person struggling with their body image or an eating-related issue. Commenting on weight, even in a more general or light-hearted way, can cause harm and intrusive negative thoughts for people at risk of developing an ED. Even if the comment is benign or if the intention of the comment is complimentary, the input is unnecessary.

How can I properly provide structure and meal support for my family with a busy schedule?

While this can vary from family to family and from schedule to schedule, overarchingly, the key is to ensure growing adolescents have three meals a day and a balanced diet of different food groups. Busy schedules lend themselves to a family-centered approach, like coming back to family meals to check in and have a sense of what is going on in everyone’s lives and monitor any patterns of behavior teens may be developing or working to overcome.

Body image issues and EDs are increasing among teenagers and children around the country. Identify concerning patterns early and work with your healthcare provider to ensure your teen receives the support they need.