When Does “Clean Eating” Go Too Far? with Dr. Edward Phillips, Associate Professor at Harvard Medical School and Juna Gjata

When you think of “eating disorders,” the image that comes to mind is probably that of a gaunt, young, white woman. It is exactly for this reason that eating disorders can often go unnoticed and undiagnosed. Someone may not fit the mold, they may not be female, young,white, or thin. Eating disorders (EDs) affect around 9% of the U.S. population. But disordered eating, a term used to describe eating disorder behaviors that aren’t necessarily severe enough to meet diagnostic criteria, affect over one in five children and adolescents, according to a new meta-analysis. 

Eating disorders and disordered eating thrive in secrecy, so detecting them in your children and teens can often be difficult. However, there are signs and clues to be on the lookout for as a parent. 

1. Excessive preoccupation with weight or shape / body checking

One of the hallmarks of EDs, and their subthreshold corollary disordered eating, is an over-evaluation of shape and weight. This means that your child or teen may place a lot of their value as a person in what their body looks like. Obsessive self-weighing, checking of particular body parts (such as “looking for abs” every morning), comparing body size to others are a few examples of behaviors that may signal an unhealthy preoccupation with body image. 

2. Skipping meals or often saying “I’m not hungry”

Food restriction is a common behavior in several of the most prevalent eating disorders. Oftentimes, a child or teen may not feel comfortable admitting that they are trying to eat less to ‘lose weight’ and so instead will intentionally skip meals, say they have already eaten at a friends’ house, or often report not being hungry. While all of these scenarios may occasionally be the case, noticing them happening more frequently may be a sign that your child or teen is restricting their food intake. 

3. Excessive food restriction or food rules

If you notice that your child or teen is afraid to eat certain foods, or perhaps is very fearful of eating too may be experiencing  disordered eating. This may manifest as restricting certain types of foods, such as sweets or baked goods, or being  inflexible about restaurant or takeout choices. For example, they may only be comfortable eating at certain restaurants they have vetted or feel are “healthy” enough and are unable or very distressed by having to improvise at new eating venues. 

4. Excessive exercising

Exercise is an important part of any child and adolescent’s healthy development, but as with all things, it can be taken too far. If you notice an unbalanced amount of exercise for the amount of food your child is eating, a feeling of “needing” to exercise, or an obsession with the amount of calories burned during physical activity, this may be an indication of an unhealthy relationship with exercise. 

5. Physical signs

Sudden changes in weight or appearance, such as rapid weight gain or rapid weight loss, are indicators to look out for that may signal drastic changes in eating patterns. Weight is an extremely sensitive topic, especially for someone struggling with their body image, so we advise not making it the focus of any discussions around the child’s eating. Other physical indicators may be constantly being cold, excessively dry skin, being low energy, or swollen cheeks (purging causes swelling of the salivary glands). 

Weight and food can be extremely tricky subjects to broach with your child or teen. But catching warning signs early can stop disordered eating from turning into a much more severe eating disorder. If you think your child or teen may be showing signs of disordered eating, speaking to their doctor is a great place to start. The National Eating Disorders Association (NEDA) also provides a whole host of resources to help you navigate this difficult issue. 

JUNA GJATA graduated from Harvard in 2017, with degrees in cognitive neuroscience and a minor in music. She is a concert pianist and composer. Gjata created and hosts the health podcast “Food We Need to Talk.” She lives in Cambridge, MA.