Seattle Dietitian Shares Common Myths and Misconceptions About Eating Disorders in Teenagers that All Parents Need To Know
By Julia Bruce, MSN, RDN, CD
Adolescents and teens are at a high risk of developing an eating disorder. In fact, the majority of eating disorders begin between the ages of 12-25 years old.
Eating disorders have a lot of misconceptions, especially with teens, and many people make assumptions about what eating disorders “look like” based on body size, gender and age. The media has only further perpetuated eating disordered stereotypes through movies, magazines, and documentaries.
It’s often overwhelming to be researching information on the web about eating disorders and it can be confusing as a parent/caregiver to know what is accurate and what is not. While stereotypes give you a frame of reference for this topic, they miss a lot of the important nuances that make a difference in your teen’s life.
Learning about eating disorder misconceptions is especially important for you as a parent because you are the primary caregiver and support for your teen.
It has been an overall trend the past two decades that eating disorder diagnoses have been on the rise. When looking at a literature review on the prevalence of eating disorders, meaning the number of individuals who have an eating disorder at a specific point in time, the percent has more than doubled over the past 20 years. It went from 3.5% in 2000-2006 to 7.8% for the 2013-2018 period. This increase has become exponentially more concerning in the past 3 years related to the COVID pandemic. An observational study looking at eating disorder clinics across the United States found that there has been a significant increase in the number of patients in both inpatient and outpatient sites since the pandemic. With the spike in eating disorder diagnoses of recent years, it is more important than ever for families to understand what is true about eating disorders and eating disorder behaviors in teens and adolescents and what is not.
Myth #1: eating disorders in teens/adolescents are a choice or a phase
Fact: Eating disorders are complex mental health conditions and not a choice. They are often rooted in a combination of genetic, psychological, and environmental factors which require professional help to overcome.
It has been thought that eating disorders were purely derived from environmental factors such as societal or family cultural pressures. While these external factors do play a big role in eating disorder development, there is also a genetic link as well. In one of the largest studies conducted on eating disorders including 17 countries from across North America, Europe, Australia, and Asia, this genetic component to eating disorders was discovered. This research is new and may bring about fascinating new insights into eating disorders and their treatments.
While it is important to recognize that eating disorder development has multiple factors at play, it is also important to note what an eating disorder is. It is not just a teen going on a diet to lose a few pounds- although this can be the start. An eating disorder is a complex mental illness with thought patterns and behaviors that develop over time. This can include:
Disordered beliefs about body
Low self-esteem
Disconnection with one’s body
Anxiety
Depression
Obsessive behaviors
Shame
Withdrawn social relationships
Self-hatred
The symptoms could go on and may be slightly different for each individual. Eating disorders often include feelings of being out of control or trapped within one’s own rules around food. They are not a phase that will naturally resolve, but rather a growing illness in an individual’s mind that often worsens if left unaddressed.
Myth #2: Only teenage girls can develop eating disorders.
Fact: White eating disorders are more commonly associated with teenage girls, teenage boys also develop them. In recent years, there has been an increase in the recognition and diagnosis of eating disorders in boys, as well as non-binary and trans teenagers.
25% of those with anorexia are male
Because males are more likely to be diagnosed later in life, they are at a higher risk of death
Men are often underdiagnosed with eating disorders because the clinical assessment tools are focused on weight loss versus building muscle
It is 7 times more likely for a queer male to have binging and/or purging behaviors than a non-queer male
It is 4 times more likely for a transgender college age student to report disorder eating behavior than a cisgender student
Rates of body dissatisfaction in transgender and nonbinary youth are 90%
It is important to be observant of all youth for any signs of eating disorder behavior regardless of their gender.
Myth #3: Eating disorders in teens are solely about food and weight
Fact: Eating disorders involve much more than just food and weight. They are complex mental health disorders that can involve distorted body image, low self-esteem, control issues, anxiety, depression, and other emotional factors. They can be a way to cope with difficult emotions or experiences by providing a sense of control.
56% of transgender people with an eating disorder believes their disorder is unrelated to their physical body
28-74% of eating disorder risk is related to genetic heritability
30% of individuals with an eating disorder have experienced sexual abuse
Myth #4: Only underweight teens can have eating disorders.
Fact: Eating disorders come in various forms, including anorexia nervosa, bulimia nervosa, and binge eating disorder.
Teens can be in any size body and have an eating disorder. Don’t wait until your teen is in a thin body to seek help. This myth is dangerous and leads to underdiagnosis and later diagnosis of eating disorders in teens and adults.
Individuals with an “overweight”* BMI are half as likely to be diagnosed with an eating disorder compared to those with a normal or underweight BMI, both having eating disorder behaviors.
Less than 6% of people with eating disorders are medically diagnosed as being “underweight”*
Larger body size is both a risk factor for developing an eating disorder and a common occurrence for people who struggle with bulimia and binge eating disorder.
In a large study including 14,322 individuals aged 18-24, it was found that 40% of adolescent girls and 20% of the boys who were in an “overweight” weight status engaged in disordered eating behaviors. This study highlights the prevalence of dangerous disordered eating behavior among individuals who are bodies of different sizes.
Myth #5: Eating disorders are attention-seeking behaviors for teens.
Fact: Eating disorders are serious medical conditions and individuals who suffer from them often feel intense shame and try to hide their behaviors. They are not seeking attention but rather struggling with internal emotional and psychological battles. Research supports early intervention when teens begin to display disordered eating behaviors to prevent further dangerous behavior patterns developing into adulthood. Any disordered behavior around food in teens should be taken seriously. Individuals who show disordered eating and dieting during adolescents are at an increased risk for developing an eating disorder into adulthood.
Nearly 10% of those with eating disorders end up dying as a result
Eating disorders are the 2nd most deadly mental health illness (1st being opioid overdose)
44% of adolescents have attempted weight loss using unhealthy weight control behaviors
Myth #6: Recovery from an eating disorder for teens is quick and straightforward.
Fact: Recovering from an eating disorder is a long and often challenging process that requires ongoing support and treatment. It’s not a linear journey and relapses can occur. It takes time, patience, and professional help to achieve sustainable recovery. Early intervention of disordered behavior is imperative when working towards eating disorder recovery and prevention. Eating disorder recovery includes three primary areas:
Physical recovery:
Weight restoration
Normalizing electrolyte and hormones
Resuming menstruation (if applicable)
Behavioral recovery, cessation of:
Food restriction
Overexercise
Purging
Psychological recovery, Work with:
Body image
Perfectionism
Food rules
Weight obsession
Mood and or anxiety disorders
Among these broader areas of recovery, it is important to be mindful of recovery maintenance and preventing relapse. Relapse rates increase during times of stress as a form of coping.
Myth #7: Eating disorders only affect teenagers from certain backgrounds or demographics.
Fact: Eating disorders can affect individuals from any background, ethnicity, socioeconomic status, or age group. They do not discriminate and can impact anyone.
Males, older adults, lower socioeconomic status individuals have all shown a rise in eating disorder diagnosis in recent years
Eating disorders impact Hispanic, Asian, and African Americans just as much as white Americans
Eating disorders equally impact people in all socioeconomic groups
Asian American reported having higher levels of dissatisfaction with their bodies and a more negative attitude toward larger bodies than their non-Asian peers
Understanding that individuals of different backgrounds can have eating disorders is important. Lack of awareness of these statistics has caused many people to be missed when it comes to eating disorder diagnosis, which delays care or leads to no eating disorder care at all. It was found that black, indigenous, and people of color (BIPOC) are significantly less likely, when compared to white peers, to be asked by a doctor about eating disorder symptoms. BIPOC are also less likely to be diagnosed and receive treatment for eating disorders although they are no less prevalent.
Eating disorder recovery in teens and adolescents: Summary
Eating disorders are a serious and complex mental illness. They do not discriminate between ethnicities, genders, ages, body size, or socioeconomic backgrounds. They are not a phase. Dieting and disordered food behavior is a risk factor for developing an eating disorder. There are multiple causes and reasons an individual may develop an eating disorder, not all primarily relating to weight and food. Any signs of an eating disorder for teens should be taken seriously and not as assumed to be an attention seeking method. They are real illnesses that are difficult to overcome. Recovery is a long process that is rarely linear.
Having a strong parent support system is important for eating disorder recovery in teens as well. Being armed with accurate information and facts regarding eating disorders is helpful and beneficial. If you suspect that your teen may be experiencing disordered eating or an eating disorder, please reach out and seek help from an eating disorder dietitian.
*For the purpose of this blog, and to use the language used in research, you'll see terms like "underweight and overweight" which is derived from the BMI scale. We as weight-inclusive dietitians do not believe that the BMI scale has any value including for teens and adolescents. Identifying bodies in this way is stigmatizing and not helpful.