How much should you worry if your teenager starts to claim she’s not hungry, eliminates foods from her diet, or expresses worry about becoming fat? When does “fussy” or diet-like eating go too far? How can you tell if a person you care about has an eating disorder, and what can you do if you suspect that she does? These are scary questions for parents and concerned others to confront. There is, indeed, a norm in our society that encourages people to value thinness, to diet even when unnecessary, and to be concerned about body size and shape. Under these circumstances, it may be hard to tell what is normal and what is not.

The signs and symptoms of eating disorders can be easily listed, and will be outlined in Part 2 of this Guide. An equally important concern, however, is how to help young people avoid eating problems in the first place.

Self-Esteem Is Essential

People who grow up with a strong sense of self-esteem are at much lower risk for developing eating disorders. Children who have been supported in feeling good about themselves, whether their accomplishments are great or small, are less likely to express whatever dissatisfactions they might experience through dangerous eating behaviors.

And yet, while parents can contribute a great deal to building children’s resilience and self-confidence, they do not have complete control over the development of these disorders. Some children are genetically vulnerable to depression or other mood problems, for example, which can affect feelings about self. Some become stressed and self-blaming as parents divorce or fight, despite adult efforts to protect their children from the harmful effects of parental discord. School and peers present stresses and pressures that can wear kids down.

All parents can do is their best; it is not helpful to blame yourself if your child does develop eating problems. Parents can, however, try to communicate to their children that they are valued no matter what. They can try to listen to and validate their children’s thoughts, ideas, and concerns, even if they are not always easy to hear. They can encourage outlets for children where self-confidence can build naturally, such as sports or music. It is critical, however, that these outlets are ones in which your child has genuine interest and experiences enjoyment; pushing a child to excel in an area in which her talents or interests do not lie can do more harm than good.

Role Models, not Fashion Models

The parents’ own attitudes and behaviors around eating, food, and body appearance can also serve to prevent eating disorders in children. Many children today witness dieting, compulsive exercise, body dissatisfaction and hatred modeled by parents. Well-meaning parents often express concern when children show natural gusto for eating fun or high-fat foods, or when they go through perfectly natural stages that involve some chubbiness.

Parents ideally should model a healthy approach toward eating: choosing nutritious foods and fully enjoying occasional treats and social events that involve food. They should model a healthy cynicism toward media images of impossibly thin people and acceptance of a full range of body types. This is challenging, given how much we all are pulled these days by powerful media and outside pressures to be sizes we cannot comfortably be. I suggest families rent Slim Hopes: Advertising & the Obsession with Thinness (Media Education Foundation, 1995, 30 minutes), an excellent and powerful video by media expert Jean Kilbourne. Watch it together and talk about it; this is a useful exercise for all children and their parents, and probably merits repeating as children grow and develop.

In Part 2 of this Guide, we focus on identifying eating disorders and getting help for the sufferer and for her family.