Spotting ED in Your Teen

Eating disorders are serious illnesses that can affect a young person’s physical health, emotional wellbeing, development, and daily functioning. Yet eating disorders in teens are not always easy to recognize, particularly in their early stages.

One reason is that many early eating disorder behaviors can initially look like fairly typical adolescent behavior. A teenager may suddenly become interested in eating “healthier,” stop eating certain foods, become vegetarian or vegan, increase exercise, or start paying more attention to nutrition. None of these changes necessarily indicates an eating disorder. But sometimes what begins as a seemingly harmless change can develop into something more concerning.

Parents are in an important position to notice these changes early. Knowing what to look for can make a significant difference.

Why Eating Disorders in Teens Can Be Hard to Spot

Adolescence naturally brings changes in preferences, independence, mood, and behavior. Teenagers may experiment with different ways of eating or become more interested in fitness and appearance. They also typically seek greater privacy and independence from their parents.

This can make it difficult to distinguish normal adolescent development from emerging eating disorder symptoms.

Eating disorders can also be difficult to detect because young people may hide their behaviors. A teen may minimize how little they are eating, exercise privately, say they have already eaten, or avoid situations in which others might observe their eating.

Parents do not need to wait until they are certain there is an eating disorder before asking questions. A meaningful change in eating, weight, exercise, mood, or social behavior is worth paying attention to.

Changes in Eating to Watch For

Changes in food choices are often among the earliest signs parents notice.

A teen may begin eliminating entire categories of food, such as carbohydrates, fats, sweets, or processed foods. They may become increasingly focused on ingredients, calories, nutrition labels, portion sizes, or whether foods are “healthy.”

Other changes may be more subtle. You might notice your child:

• Eating much more slowly than before
• Cutting food into unusually small pieces
• Moving food around the plate rather than eating it
• Eating foods in a rigid or particular order
• Preparing increasingly elaborate meals for others while eating very little themselves
• Becoming distressed when meals do not go according to plan
• Frequently saying they already ate
• Wanting to eat alone or in their room
• Leaving for the bathroom immediately after meals

Any single behavior may have an innocent explanation. What matters is the overall pattern and whether eating seems to be becoming increasingly rigid, stressful, or avoidant.

Pay Attention to Weight and Growth

Weight loss in a growing child or teenager deserves attention.

Parents sometimes assume that weight loss is healthy if a child began at a higher weight. This can be particularly problematic because eating disorders occur in young people across the full range of body sizes.

A teenager does not need to appear extremely thin to be medically compromised by an eating disorder. The amount and speed of weight loss, the child’s previous growth trajectory, nutritional intake, and physical symptoms all matter.

Regular pediatric visits provide an opportunity to review height, weight, and growth patterns. If you notice significant changes in eating or have concerns about weight loss, you do not need to wait for the next annual physical to request an evaluation.

Notice Changes in Mood and Social Behavior

Moodiness and a desire for greater independence are common during adolescence. More significant changes, however, can accompany an eating disorder.

Look for increased irritability, anxiety, isolation, depressed mood, or withdrawal from friends and activities. A teen may also begin avoiding situations involving food, such as birthday parties, restaurants, family dinners, sleepovers, or meals with friends.

Eating alone can become particularly appealing because it allows eating disorder behaviors to continue without observation.

Sometimes these social changes occur before parents recognize that food is at the center of the problem.

When Exercise Becomes Compulsive

Exercise can be another place where eating disorder symptoms hide in plain sight.

Pay attention to whether exercise has become rigid or driven rather than enjoyable. Does your teen become extremely upset if they miss a workout? Do they exercise despite illness, exhaustion, injury, or competing obligations? Are they adding exercise secretly or constantly trying to increase their activity?

The risk can be particularly difficult to recognize among dancers, gymnasts, wrestlers, runners, and athletes in sports where weight, shape, or performance are closely connected. Behaviors that might otherwise raise concern can easily be interpreted as dedication to the sport.

Physical Signs Parents Should Know

Eating disorders can affect nearly every system in the body. Possible warning signs include:

• Low energy or unusual fatigue
• Frequently feeling cold
• Dizziness or fainting
• Difficulty concentrating
• Changes in sleep
• Gastrointestinal complaints
• Menstrual changes or loss of a menstrual period
• Delayed puberty
• Fine hair growth on the body associated with significant malnutrition

Physical symptoms should always be evaluated medically, particularly when they occur alongside changes in eating, weight, or exercise.

What Should Parents Do If They Are Concerned?

If you notice a significant change in your child’s eating, ask about it. Parents are sometimes hesitant because they fear saying the wrong thing or provoking an angry response. But avoiding the subject generally does not make the problem go away.

Try to approach the conversation with curiosity rather than accusation. Focus on the changes you have observed rather than on appearance.

You might say that you have noticed your child is eating less, avoiding meals with the family, or exercising much more than usual and that you want to understand what is happening.

If your teen becomes defensive or insists that nothing is wrong, that does not necessarily mean there is no reason for concern. Continue paying attention and seek professional guidance when warranted.

Early Treatment Matters

If you suspect an eating disorder, seek an evaluation from a professional with specific expertise in eating disorders. Early intervention is associated with better outcomes and can help prevent eating disorder behaviors from becoming more entrenched.

Treatment should directly address the behaviors that are maintaining the eating disorder, including inadequate nutrition, restriction, binge eating, purging, compulsive exercise, or other problematic patterns.

For children and adolescents with anorexia nervosa, Family Based Treatment, or FBT, is one of the most strongly supported treatments. Parents play an active role in helping their child restore adequate nutrition and interrupt eating disorder behaviors.

FBT can also be used for adolescents with bulimia nervosa. For binge eating disorder and other eating concerns, treatment may include approaches such as Enhanced Cognitive Behavioral Therapy, or CBT E, along with meaningful parent involvement and support.

The right treatment depends on the young person, their symptoms, their age, and the nature of the eating disorder.

Parents know their children. If something about your teen’s eating, exercise, weight, or behavior feels significantly different, it is worth investigating. You do not need to wait for an eating disorder to become severe before asking for help.