When Equip’s Senior Manager of Content, Kate Willsky, describes the development of her eating disorder and first memories of body image issues, it’s like she’s describing my own millennial upbringing. “My eating disorder began in the summer between 5th and 6th grade, when I was 11,” she says. “I remember in elementary school becoming increasingly aware of my body size, and comparing it to the images I saw on TV or in Seventeen Magazine or the Delia’s catalog.”

Willsky began reading nutrition labels and routinely doing abdominal crunches, two habits that I also adopted in middle school. At her annual checkup, Willsky’s doctor noted that she’d grown in height but lost weight. “I mentioned that to a teenage camp counselor that summer, and I remember her saying, ‘oh wow, I wish I could do that,’” she says. “Everyone noticed my weight loss and praised it at first.”

From that moment, Willsky says, things quickly accelerated. Her eating habits became more rigid as she carefully monitored fat grams and measured her morning cereal. She began skipping dessert and exercising in secret, eventually setting her alarm so she could wake up in the middle of the night to work out on her bedroom floor. “By the autumn of 6th grade, I'd been diagnosed with anorexia,” she says. “By December of that year, I was admitted to the hospital for inpatient treatment.”

While my own eating disorder progressed at a different pace (my anorexia diagnosis came in high school, followed by years in and out of intensive outpatient programs), Willsky and I share one distinct commonality: our illnesses took root during the impressionable years of adolescence.

While eating disorders can affect anyone of any gender, sexual orientation, age, race, and socioeconomic status, they’re ranked as the third most common chronic illness in adolescent females specifically, with an incidence of up to five percent. Read on to learn why adolescence is such a vulnerable time for individuals prone to developing eating disorders, how to help prevent these illnesses, and how to get help if you’re concerned about an adolescent in your life.

What the research says about eating disorders in adolescence

Defined by the World Health Organization (WHO) as the ages from 10 to 19, adolescence is the most common life phase for eating disorder onset, which typically occurs between ages 12 and 25. According to a recent systematic review and metaanalysis, the global overall proportion of children and adolescents with disordered eating from 1999-2022 was 22.36 percent. Disordered eating appears to be more common in girls (30%) than boys (17%), and the numbers are increasing among older adolescents and adolescents with higher BMIs.

“The most common eating disorder across all age groups in the United States is binge eating disorder, but adolescents can have other eating disorders including anorexia nervosa, OSFED or atypical anorexia, bulimia nervosa, or avoidant restrictive food intake disorder,” says Equip psychiatrist Dr. Barbara Kessel, DO, CEDS. “Eating disorders can happen to kids of any size and occur in adolescents from all races and ethnicities.”

Signs of adolescent eating disorders

Eating disorders can show up in a variety of different ways, and many of the hallmark behaviors occur in secret, making them particularly tough to spot. However, if you’re the parent or guardian of an adolescent, you’ll likely be able to notice at least some changes that may indicate there’s a cause for concern.

According to Kessel, the most common warning signs of eating disorders in adolescents include:

• Changes in diet. This could include things like skipping meals, eating alone or avoiding activities involving food, cutting out previously favorite foods or entire food groups, over-focusing on certain macronutrients like protein, or going on diets.
• Changes in exercise habits. This might look like exercising in addition to designated sports practice times or sacrificing sleep or certain activities to work out.
• Concerns over body image. This can show up as a preoccupation with appearance, body checking, or wearing baggy/loose fitting clothing to hide their body.
• Changes in other food- or body-related behavior. This could include hiding or sneaking food, tracking calories, or weighing themselves frequently.
• Mood changes. While this can often show up as withdrawal, sadness, or having a flat affect, adolescents with eating disorders may also become angrier, more irritable, or more childlike, among other potential mood changes.

“Eating disorders can be difficult to spot in the adolescent age group because adolescent bodies are rapidly changing as they undergo pubertal changes,” Kessel says. “Puberty is also commonly associated with changes in mood or irritability from a child’s earlier baseline. This can be confusing for parents and cause them to want to ‘back off’ for fear of rocking the boat or further agitating their adolescent. This is understandable, but it only leads to eating disorders being missed for a longer period of time.”

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Why adolescence is a high-risk time for eating disorders

“Adolescence is a time that is fraught with changes,” Kessel says. “Pubertal changes can be scary and difficult for some, and this time often comes with changes in peer groups and increased complexity of relationships. Not all kids develop at the same time or same rate, making comparisons to peers a potential challenge.Girls who develop earlier or are on higher percentiles for height and weight are known to be at higher risk for developing an eating disorder.”

In addition to the inevitable and often-uncomfortable changes of puberty, Kessel says one of the biggest risk factors for developing an eating disorder at any age is going on a diet. According to one recent study, engaging in any type of dieting in the past 12 months was associated with greater eating disorder psychopathology in most groups. Unfortunately, research shows that many adolescents pursue dieting: according to data from the National Health and Nutrition Examination Survey, 37.6 percent of adolescents aged 16 to 19 tried to lose weight in the past year, with weight loss attempts higher among adolescent girls (45.2%) compared with adolescent boys (30.1%).

Some other common eating disorder risk factors for adolescents include:

• Social media use. One study found that the “misuse of social media platforms” in adolescents is likely a significant contributing factor to the rise of eating disorders.
• Body-focused sports that encourage weight loss. Studies show that sports and activities that encourage weight loss or emphasize thinness like wrestling or ballet may put adolescents at a higher risk for eating disorders.
• Family history. Studies have found increased rates of eating disorders in relatives of those with anorexia and bulimia, and a first-degree relative of someone with an eating disorder is up to 12 times more likely to develop one than a person without a relative who has an eating disorder.

For Willsky, the social upheaval caused by the transition from elementary school to middle school made her existing problems worse. “I remember being so overwhelmed by the cliques forming and the politics of popularity, and feeling comforted by the simplicity and clarity of my eating disorder's rules,” she says. “There was also the new pressure of dating, crushes, boyfriends, and being attractive to the opposite sex. I wanted to be pretty, to meet the beauty ideals I saw all over movies and TV shows and magazines—and everything I heard and read told me that if I wanted to achieve that, I had to be thin and ‘toned.’”

How parents can help prevent eating disorders in adolescents

There is no single cause of eating disorders, nor is there one single, guaranteed prevention strategy. However, there are parenting strategies that can help minimize the risk of eating disorders in adolescents, and everyday habits that can foster a healthier mindset around food, exercise, and body image.

“Parents certainly can’t control everything in their adolescent’s life,” Kessel says. “In fact, this is really a time in their child’s life that they should be experimenting with increasing independence and autonomy. But, there are some things that are proven to decrease the risk of an adolescent developing an eating disorder.”

Here are a few prevention strategies to consider:

Demonstrate healthy attitudes.

“Watch your own language and audit your own internal beliefs,” Willsky advises. “I still remember things my parents said, with no ill-intent, that lodged themselves in my mind and fueled the eating disorder—for instance, the idea that you ‘earn’ or ‘deserve’ food through physical activity.”

Kessel agrees that eating disorder prevention starts in the home by promoting a body-positive environment and modeling an ‘all foods fit’ attitude to nutrition. “This means working on not moralizing foods or bodies as ‘good’ or ‘bad,’ while modeling that varied diets and body types are all part of living life,” she says. “This might mean parents themselves working on their own relationships with food, exercise, and their own bodies. Parents can try to model a positive relationship with their own bodies, exercise, and with food, and if parents are struggling with this, they should consider talking with a professional.”

As often as possible, eat together.

“Having regular family meals is a great way for parents to keep a pulse on how their kids are relating with food and provides an opportunity to improve connection within the family,” Kessel says.

Keep close tabs on social media use.

“I would recommend keeping kids off of social media altogether for as long as possible,” Kessel says. “Social media use has been shown to increase risk of eating disorders, disordered eating, depression, and anxiety. If parents allow social media, I recommend that they limit time allowed on the apps and discuss the dangers involved. Teach kids how to spot ads and accounts that might be profiting off of their insecurities and to think about them critically. Parents should require they have access to their adolescent’s accounts and check in on them regularly.”

Don’t hesitate to seek support.

“If you're concerned, get help immediately,” Willsky advises parents. “The longer these illnesses have to take hold, the more entrenched they become. I know that part of the reason my anorexia accelerated so quickly was because I had time to lose weight, and my malnourished brain fueled the disorder. If you're worried, talk to a professional. Even if your child doesn't have an eating disorder, it's better to be safe than sorry.”

Persevere through pushback.

“I know that my parents were scared to make me mad—scared that if they pushed too hard I would retreat and close them out,” Willsky says. “But the reality is, if your child has an eating disorder, this is inevitable. The eating disorder will get mad, and get loud, and your kid needs you to fight back, because even though it seems like you're fighting with your child, you're really battling the illness that has them in a chokehold. They will not stop disordered behaviors of their own accord; they need their parents to help them. And though they may kick and scream and say horrible things in the moment, they will be thankful in the end.”

Treatment for eating disorders in adolescence

While there are a variety of evidence-based treatment options available to those struggling with all forms of disordered eating, only one is considered the gold standard of care for treating eating disorders in young people.

“The treatment modality with the most robust evidence in treatment of adolescent eating disorders is family-based treatment, or FBT,” Kessel says. “FBT is a manualized treatment that requires specialty training, and parents should look for providers or programs that offer treatment based on this model. It requires heavy involvement from parents early on in the treatment, with parents gradually guiding their adolescent back to age-appropriate independence over time.”

When choosing the type of treatment that will work best for an adolescent, Kessel advises parents to consider the severity of their child’s illness as well as their own ability to supervise the early stages of recovery and participate in treatment. “It is best to keep an adolescent in the least restrictive environment where they will have an opportunity to be successful,” she says. “Thus, allowing them the least interruption to school, activities, and relationships as possible for the shortest amount of time. Options should be discussed with your child’s PCP or mental health providers.”

What to do if you’re worried your adolescent might have an eating disorder

While it can feel overwhelming or even scary to confront the possibility that your child has an eating disorder, intuition and early action can be life-saving. “If you’re concerned that your child might have an eating disorder, listen to your gut,” Kessel says. “It’s best to bring up your concerns to both your child and their PCP. Don’t wait. The earlier an eating disorder is detected and treated, the higher likelihood that your child will be able to achieve a long and meaningful recovery.”

While parents can have a profound impact and influence on their child’s recovery, it’s also critical to understand that parents are not the cause of their child’s eating disorder. “When an adolescent develops an eating disorder, it’s no one’s fault, and they are not a choice,” Kessel says. “Eating disorders have complex causes including genetic risk factors, developmental risk factors, psychological risk factors, and sociocultural risk factors. Once an eating disorder has taken hold, there are biological and psychosocial factors that contribute to maintaining them. Adolescents need consistent and loving support from their parents to make recovery possible.”

Willsky agrees, reiterating that eating disorders are not the fault of parents, but parents do play a pivotal role in helping their child recover. “This is something we say a lot at Equip, but it's really, deeply true,” she says. “It won't help anyone to blame yourself or try to trace the ‘trigger,’ but it will help to band together as a family and help your child beat the eating disorder.”

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FAQ

How common are eating disorders in adolescents?

The global overall proportion of children and adolescents with disordered eating from 1999-2022 was 22.36 percent. Eating disorders appear to be more common in girls (30%) than boys (17%), and the numbers are rising in older adolescents and adolescents with higher BMIs.

Why is adolescence a high-risk time for eating disorders?

The physical and mental changes that accompany puberty can be triggering in and of themselves, but adolescence is also a time of intense social change. Engaging in dieting behavior (which is common during this time), using social media, and participating in body- or weight-focused sports can also increase the risk of developing an eating disorder.

How can parents prevent eating disorders in adolescent kids?

While there is no single prevention strategy against eating disorders, parents can make a big difference in reducing the risk in their children by modeling healthy behaviors toward food, exercise, and body image. Regularly eating dinner as a family, delaying social media use, and seeking support when necessary can all contribute to a reduced risk in eating disorder development.

How are eating disorders treated in adolescents?

Family-based treatment (FBT) is considered the gold standard of care for adolescent eating disorders. This manualized treatment requires specialty training and the heavy involvement of parents who can help guide their adolescents back to age-appropriate independence over time.