Recognising Eating Disorders In Kids And Teens: A Guide For Parents

Eating disorders in children and adolescents are complex challenges that affect both physical health and emotional well-being. Read on for tips on spotting the initial signs, as early identification and support can be life-changing.

It’s every parent’s fear: noticing something off about your child’s eating habits but not knowing how serious it might be. Dr Amanda Oswalt Visher, Director of Psychological Services at SPOT and a specialist in child and adolescent mental health, offers guidance on recognising eating disorders and supporting your child through recovery. She says, “Eating disorders can feel like a hidden struggle for families. Kids might not always talk about it, and sometimes the signs are subtle. But early recognition can make a huge difference in the outcome.”

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Spotting the Early Signs: More than Just Food

Amanda explains that parents should watch for common physical changes like rapid weight loss, fatigue or stomach problems. She says, “For girls, missed or irregular periods can be a red flag too. But beyond the physical, it’s the behaviours that often tell a deeper story.”

These behaviours might include avoiding certain foods or food-related social events, an intense preoccupation with calories, or even secretive actions like sneaking food or excessive exercising. “Sometimes kids wake up early just to burn extra calories or check their health apps obsessively. That’s a sign the issue goes beyond eating and into how they’re feeling about themselves,” she says.

Weight changes can be significant in diagnosing an eating disorder, but it’s not the only factor. Patterns that may raise concern include a rapid weight loss or gain of 15% or more of body weight over a few months and significant fluctuations in weight, such as losing and regaining the same amount repeatedly. Amanda says that these changes catch attention; it’s so much more than numbers on a scale. Even if weight looks stable, the mental and emotional toll of disordered eating can be severe.

Physical and Behavioural Warning Signs To Keep An Eye Out For

• Food rituals, like avoiding certain foods or compulsively rearranging items on the plate.
• Social withdrawal, especially during meal times or food-related events.
• Preoccupation with body image, dieting or calories.
• Dramatic changes in eating habits — skipping meals, binge eating or extreme dieting.
• Excessive and compulsive exercise routines.
• Secretive behaviours such as hiding food, sneaking snacks at night, or frequent bathroom visits after meals.
• Using apps to track food intake when not necessary: Unusual adherence to self-inflicted rules around calories and fat.
• Going to the bathroom after meals. This may be to purge the food they had just consumed.
• Sneaking food at night. Often, those with ED do not like to eat in front of others and/or they will have starved too much in the day and can no longer withhold at night. This being said, teenagers tend to be nocturnal and more ‘snacky’ at night, especially if they are staying up late to study.
• Buying more food than needed: This is often to consume in private and later purge (either by throwing up, exercising or limiting food intake later). These foods tend to be high in calories, crunchy and overly sweet or salty.
• Hiding food and wrappers: So as not to get ‘caught’ for eating (even if they would have been permitted to eat such foods, they do not want others to know what they eat or when). 
• Looking up food recipes and videos for cooking, then refusing to eat the food they make.
• Refusing to go out for meals, because they do not know how the food was prepared and how much oil, sugar and butter are in it.

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Why Mental Health Matters

Eating disorders rarely exist alone. They often intertwine with low self-esteem, anxiety, perfectionism, depression, and sometimes co-occurring conditions like OCD, autism and cutting behaviours. Amanda says, “Adolescents today face extra pressures from social media and peer influences, which can distort their body image more than previous generations, making them feel isolated or ‘not enough.'” Youth may experience eating disorders differently from adults, explains Amanda, who says adolescents often show more impulsiveness or binge behaviours, heavily influenced by peer pressure and social media’s unrealistic body ideals.

Amanda dispels common myths that eating disorders are just phases or attention-seeking, emphasising that they are serious conditions with potential lifelong impact, including brain function impairments, cardiovascular risks, and in severe cases, death. Early intervention is essential to prevent lasting harm, and holistic treatment addressing both mental and physical health can drastically improve outcomes.

Additionally, certain communities may be more likely to face unique challenges. These include:

• Children on the autism spectrum may develop rigid eating patterns or sensory aversions, complicating disorders like avoidant/restrictive food intake disorder ARFID.

• Teens in the transgender and LGBTQIA+ communities often confront body dysphoria, heightened by societal pressures and media influence.

• In Hong Kong, intense academic and societal expectations create fertile ground for perfectionism-driven eating disorders.

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Approaching Your Child with Compassion

For parents wondering how to start a conversation, Amanda suggests an approach emphasising patience and care. She says, “Don’t bring it up during meals, and avoid focusing on weight. Try to talk when you’re doing something else together, like driving or walking, so it feels less intense.” Using gentle “I” statements can open doors: “I’ve noticed you seem upset around food lately, and I want you to know I’m here for you.” Building trust and keeping communication open without judgment encourages children to share their feelings in their own time.

Balancing directness with empathy requires acknowledging the individual’s feelings to reduce defensiveness and creating a supportive environment by asking open-ended questions that encourage open dialogue instead of confrontation. Maintaining ongoing communication and support is equally important, which can be done through regular check-ins to understand how they feel about their eating habits and body image.

Tips For Creating A Safe Environment

• Create a safe space encouraging open dialogue without focusing solely on food or body image.
• Building rapport: Establishing trust through empathy and understanding.
• Maintain ongoing communication with regular check-ins and share positive resources about body image.
• Involve children in treatment decisions to empower them and build trust.
• Not focusing on food and weight, especially at the beginning: Eating disorders are a symptom of a larger issue, and if caregivers focus too much on food and body, this can make the child more guarded and resistant to recovery and honesty.
• Collaborate with specialised professionals experienced in their child’s unique background and needs.

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The Healing Journey: Teamwork and Empowerment

“A child’s involvement in their own care is crucial. Help them research professionals or treatment options and empower them to make choices. This builds ownership and hope,” says Amanda. She reminds parents they don’t have to face this alone, and can collaborate with therapists, nutritionists and teachers, each playing a part in helping your child heal. This can be achieved by discussing treatment options openly, allowing them to share their preferences and concerns. It is also vital that the entire treatment team communicates and coordinates effectively. Empowering the child with choices related to their care helps cultivate a sense of control and responsibility, which can enhance their motivation and confidence throughout treatment.

Involving parents or caregivers in identifying and assessing a child’s needs is crucial, yet it must be approached with sensitivity to preserve the child’s trust. Additionally, educating parents about the signs and symptoms in a calm, non-alarming way helps them understand the situation without causing undue worry. Such a balanced approach ensures that the child feels supported while parents are empowered to contribute effectively to the process.

Resources for Parents

Amanda says, “When an eating disorder takes over, kids can lose sight of who they are beyond it. Encourage hobbies, creativity and friendships — they remind children of their worth beyond body and diet.” She recommends the following resources for parents to start conversations around healthy eating and body image:

• Books on body positivity: Finding age-appropriate literature that promotes healthy self-image.
• Recommend following influencers who promote a healthy relationship with their bodies and celebrate well-being and achievements, rather than those who might inadvertently encourage unhealthy comparisons.
• Workshops or classes: Encouraging attendance at nutrition workshops or family health classes.
• Do what brings joy and pride: Often, when an eating disorder gets severe, the child and family’s life and identity can start to revolve around this.

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