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In a world where size 4 models are considered curvy, Beyoncé is applauded for dropping 60 pounds of baby weight in just a few months and 19-year-old Miley Cyrus is on Twitter touting a gluten-free diet and Pilates regimen, it’s hard to claim to young girls that being skinny isn’t important. The pressure begins to mount during the teenage years, and many girls start dabbling in diets and new lifestyle habits. But when a health food kick slowly turns into an obsession, you might wonder if her diet has crossed the line from healthy to dangerous.
“There becomes a confusion between getting healthy and getting thin,” says New York nutrition therapist and dietitian Sondra Kronberg, who specializes in the treatment of eating disorders. “It’s taking what society tells us is healthy to an extreme. First, what they eat gets very narrow, and then it becomes very rigid. It becomes eating by numbers, not by taste, nutrients, pleasure or health.”
In today’s culture, the pursuit of health and a slim physique are often branded as one and the same. It can be hard to discern what’s normal behavior anymore, since it’s easy to pass off damaging eating habits as healthy lifestyle choices. Getting to know the facts and warning signs can help parents keep their daughters from crossing the line into disordered eating.
One precursor of an eating disorder is one most girls will do at some point, or at least contemplate. “As soon as she goes on a diet, it’s a warning sign,” says Carolyn Costin, executive director of Malibu, Calif.-based Monte Nido and Affiliates, a treatment center for body image and eating disorders. According to the National Association of Anorexia Nervosa and Associated Disorders, 91 percent of college-age girls reported attempting to keep their weight in check by dieting.
From the start of any dieting, watch for restrictive behavior surrounding food, which can become more extreme. “The spectrum of what they eat will become more narrow,” says Kronberg. “Instead of eating the pizza, they’ll only eat a salad with grilled chicken and no dressing. There is an accelerated fear of fat. If they hear ‘low-fat’ means a food is good, then ‘no-fat’ means it’s better.”
And as the eating disorder starts to take hold, you may see mental changes in your daughter. “My daughter's grades suddenly dropped, her friends started staying away, and she got really cranky and distant,” says mom Becky Henry, whose daughter suffers from bulimia. “She also started being really crabby at meal times. Very bizarre ‘rules’ about food became the norm, like only orange foods, or only white foods, or no white foods.” If it seems odd or unhealthy, it likely is. Look for the symptoms of different disorders, based on your child’s tendencies and personality.
She’s so thin, and everyone is noticing, yet she looks in the mirror and thinks, “I’m fat.” That’s anorexia nervosa at its core, where sufferers starve themselves to compensate for a skewed notion of their bodies. They have an intense fear of gaining weight, and refuse to maintain a healthy Body Mass Index (BMI).
If your daughter can seemingly juggle it all—a math whiz, class president and type-A personality—she may be more likely to fixate on the calories, numbers and figures surrounding weight. If she starts explaining how she’ll need 36 minutes of treadmill time as a trade for that small slice of cake, keep an eye out. “Perfectionists who are tenacious, love control and are socially probably a bit more nervous, tend to be at risk for anorexia,” says Costin. “They’ll be more likely to keep track of every calorie, to count out and measure food.”
She might also change from bubbly to reserved. Lydia* watched her 11-year-old become more and more internal as anorexia took over her life. “I saw my daughter, who was always an outgoing, confident girl, become more and more introverted,” she says. “The girl who could make friends in any room could no longer order dinner for herself at a restaurant, a skill she'd had since the age of 3 or 4.”
Signs of anorexia include missed periods and not wanting to eat out—she may insist there is nothing on the menu for her at a restaurant. She’ll obsess over certain foods she feels comfortable consuming. She may start a restrictive diet, such as becoming low-carb, gluten-free, vegan or vegetarian. You may not see her actually eat at home anymore, or only push the food around her plate when she is given a meal. Emotional ups and downs are common; malnourishment means sufferers don’t have the nutrients or physical capabilities to keep their hormones and feelings in check. According to mom Sarah, to her own shock and confusion, this happened to her daughter, who later confessed to an eating disorder. “Her moods had become very volatile,” she says. “About three months before she came to us, she was having outbursts and tears and rages over things that didn't match her reaction. I kept having a nagging feeling that something wasn’t right”
*Name has been changed.
It’s also important to keep in mind that a symptom of anorexia is denial—not only that she is possibly in some kind of danger, but even that she is thin at all. She may have a problem, but won’t be able to acknowledge it.
If anorexia is characterized by intense control, bulimia often has to do with feeling a loss of control. If girls prone to anorexia tend to be color-inside-the-lines types, teens prone to bulimia tend to be the wild-child kids. Sufferers eat excessively, feel guilty and then purge—whether it’s throwing up, fasting, taking laxatives or using diuretics. And as they begin taking chances with their health, they tend to take more chances with their lives, too.
Henry saw her daughter’s altered mental state firsthand. “She was engaging in very risky behaviors, from driving too fast to stealing things,” she says. “She began stealing money from my purse to buy her binge foods, and stealing my makeup. Her friends finally confirmed my worries, as the pediatrician and two psychologists didn't believe me and fell for her lies.” Where anorexia brings on denial of a disorder, bulimia brings on shame over a disorder.
According to Costin, Henry’s daughter’s behavior is consistent with other cases. “Bulimics tend to be impulsive, risk takers, they’re sometimes involved in drugs,” Costin says. “A lot of times they’ve been bullied or teased at school for being overweight. A lot of them are in competitive sports, where there is an added emphasis on being thin, like gymnastics, dance, ballet or even swim. The competitive nature sometimes lends itself to an eating disorder.” Costin says she’s even treated professional athletes and Olympians at Monte Nido.
With bulimia, girls will often disappear immediately after meals to purge. Many of them will have scars on the backs of their hands from scraping against teeth while forcing themselves to throw up. They’ll have bloodshot eyes. They’ll make excuses for refusing food, saying they’re sick or full. You may find them with laxatives. And even if they claim the pills are for a friend, take it as a warning. “Don’t necessarily assume they have a disorder, but that should at least be enough to get [the possibility of a disorder] on your radar,” Costin says.
Another eating disorder that’s on the rise is extreme exercise. Some teens will abide by a strenuous physical regimen, pushing themselves to burn more calories than they consume in a day. They’re convinced that if they don’t exercise constantly, they will gain weight. “They may be athletes,” says Costin, “but more importantly, these are just highly driven people.”
She may also insist on an everyday routine, even trudging to the treadmill when she’s tired, sick or injured. Another key thing to consider: Are her exercise habits hindering her ability to live a normal life? If she refuses to go out to the movies with her friends because she’s afraid she won’t get her workout in, then there’s a problem.
“When thoughts or behaviors interfere with quality of life, that’s when I qualify it as a disorder,” Kronberg says. “To the degree that it’s happening, that’s the degree of their eating disorder.”
As with anything, the easiest way to prevent a disorder is to stop it before it starts. “I always tell parents to get the scale out of the house. Even if their child is technically ‘overweight,’ it should always be about health,” says Costin. “The number doesn’t matter. Instead, is she active? Is she eating a balanced diet? The thing I’ve learned after 35 years of working with eating disorders—the thing I try to preach most—is health, not weight. We’ve gotten so appearance-focused.”
And these pressures are especially prevalent among women. Costin reminds moms to be the first role models for their daughters when it comes to a healthy body image. “How mothers treat their own bodies is key. Daughters will try to keep up; keep the weight off, keep up with extreme exercisers," she says. "What you say is also huge, and what you say about your own body.” If you get focused on thinness instead of healthiness, and only talk about your body with negative words, then your daughter will do the same.
Take the focus off looks. Remember to praise the qualities of character that make your child such a wonderful human being, says Costin. “One of the girls I worked with, her parent was praising her appearance, looking at a photo of when she ‘had lost weight and looked so good,’” she says. “But when that parent left, the daughter told me that at that time, she had been throwing away her lunch every day, starving herself. The lesson is that even if your daughter is thin, you may not know what she did to get to that point.”