Disordered Eating Behaviors and Eating Disorders Part II: Prevention
In my previous newsletter (Eating Disorders and Disordered Eating Bahaviors Part I), I discussed about disordered eating behaviors and eating disorders and what definition of each term entails and what are the symptoms that we need to be aware of. In part II, I want to focus more on potential prevention strategies and things we can do in our daily lives and small tips to help them keep in the right lane when it comes to food.
What Can We Do To Prevent This?
Unfortunately, eating disorders are sneaky, dangerous and can be socially contagious. Therefore, there is not a fool-proof way of preventing it to happen, but there are things that we can do in our day to day lives that can reduce the risk of developing them. Creating a healthy and balanced eating habit from a very young age - from the moment our children move to solid foods - should be our first and foremost priority.
We Are The Boss - We are the parents and we need to decide what to serve in our kitchens. From the moment our children start eating solid foods, the rule should be ‘everybody eats the same thing’. Long gone the days where you prepare different breakfasts for each member of the family to cater to their preferences. Aside from allergies and other health conditions to be taken into account, what’s been prepped in the kitchen by the adults should be consumed by everyone.
We tend to give too much autonomy to our kids when it comes to food. We must decide how, when and what will be consumed and our children should decide how much they consume. Even if they do not like the food you are serving, all they should be required is to try and have a spoonful of it. One spoon is more than enough. If they do not like it, they can eat other things that are on the table, but no replacement! They should not be allowed to pick anything they want from the fridge.
When our daughter was very young, I had come across a phenomenal research that changed my view on eating preferences. It turns out, we need to try a certain food at least seven times (sometimes up to 15 times) before we like it. Say, I do not like spinach, if I try at least seven times on different occasions, at some point I start liking it. I have used this strategy with my daughter over the years with so many things like eggs, salmon, brussel sprouts and our Mount Everest: peas! Not once it failed. I served these foods casually over and over again and asked her to take a spoon of it, nothing more. No bribing, no cajoling, simply serving it casually and reminding her of our ‘single spoon’ rule. I made sure that there were other dishes or courses ready at the table, if she did not want to eat more than one spoon.
Children with sensory processing challenges may avoid certain textures of food, even sometimes food with certain colors. Depending of the severity, this may create serious challenges for families at mealtimes. However, avoiding certain foods or food groups due to sensory processing disorder may put our children in higher risk of developing eating disorders. Therefore, we should keep good faith, try to be positive and hopeful whilst calmly and casually continue to serve these foods at mealtimes and ask them to give it a try. If they say no, move on! Do not make a big deal, and offer other dishes that are on the table… Do not despair… Continue to serve that food again and again… The trick is to take away the power from our children. If you do not make a big thing out of their avoidance, eventually they may give it a try. Even if they never do, as this may happen with neuro-divergent kids, you are still instilling healthy eating habits…
Young children, tweens and teenagers can decide how much they eat, but not what they eat, at least until they are at a certain age. Dr Hildebrand from Mount Sinai Hospital, an expert on eating disorders, states that there is no set age for that, but he suggests that we should wait at least until our kids can self-initiate school homework. And when it’s time, we start slow… Maybe bereakfast, or dinner… However, for families, where children choose what they eat at school lunch, I would say start even later, as they already choose their lunch. I think, it’s better we choose what they eat at breakfast and dinner when we are eating at home.
“Add Mindset” Rather Than “Delete Mindset”- According to Dr Hildebrandt the idea of eliminating certain foods, even if they are unhealthy foods, is not a good idea. When we set a rule of eliminating sweets and deserts all together, we may be pushing our children towards binge eating as the natural response to deprivation is to binge. Moreover, when we exclude a food group as a part of ‘healthy diet’ we may be modelling behaviors that may lead to restrictive eating disorders.
If our child has a sweet tooth and they want to eat cookies as an afternoon snack, Dr Hildebrandt suggests, we should think in terms of adding rather than eliminating food and should offer our child some healthy snacks like fruits or nuts and say “if you are still hungry after eating these of course you can have a cookie.” Eating habits that combine cakes, icecream and cookies with vegetables and fruits provide the optimum result in protecting our children against disordered eating behaviors and eating disorders. Experts suggest that having guard rails on what to eat and how to eat is better than having strict rules about food.
Invest in a good tailor - Pubescent bodies change profoundly. They gain weight and height and for some children the change happens overnight, others in a glacial pace. They will feel self concious about their bodies, and their clothes may not necessarily fit well. How they see themselves in clothes can enhance body image issues. They would feel good and comfortable in their own body when their clothes fit them well.
Monitor their social media exposure - Talk, talk, talk! Talk about the images they see, talk about photoshop and how they work… Show them and let them play with photoshop apps so that they understand how much one can change an image through it. Talk about how long it takes for those influencers to take one good photo and that nobody puts up a bad photo of themselves. Therefore, we do not know how those people look in real life. Awareness is important! Then, incessantly, make sure that they are aware of how ordinary people they see at the school, streets, restaurants look… According to Dr Lisa D’Amour, one of the reasons why eating disorders in young people exploded during Covid lockdowns is that kids were being bombarded with unattainable body image content in social media. The second, they were not able to go to out and see that in day to day normal life nobody looks picture perfect. This needs to be actively discussed and stressed with our kids.
You may wisely have delayed social media for your child and that they may not have access to it. However, do not be fooled by that. Our children are being continously exposed to these images through their ordinary lives. Therefore, do talk about these things. And, if you realise that your child is already being exposed to a written content about dieting or exercising or these images through any type of media, do not refrain yourself from restricting and controlling their exposure whilst talking to them about this issue. Teenagers, by nature, hate to be used and manipulated by other people. Talk to them about how these media giants are manipulating them into selling their products! They won’t like being used!
Regular Eating- Dr Hildebrandt suggests that regular eating is the simplest and the most effective prevention tool against the most toxic and the most dangerous eating disoders. Unfortunately, in today’s culture of ordering food whenever and wherever we want, he adds, it is the most difficult measure to adopt.
This actually brings us back to our first point; we decide when to eat, meaning only at mealtimes! Dr Hildebrandt suggests that if a person eats 3 main meals with one or two small snacks depending of the length of their awake hours, the possibility of developing overweight or underweight problems become very slim. Therefore, the kitchen should not be open 24/7.
Family meals- I have spoken about the importance of having regular family meals with our children in one my earliest newsletters. For those who want read or re-read the link is (Benefits of Regular Family Dinners). In regard to eating disorders, this is very important for two reasons. One, regular family meals is a well-establised way to make sure we offer a balanced diet. Therefore they consume a healthy diet and they first hand learn what that looks like. You are also modelling best practices around healthy eating in a natural way. Second, regular family meals is a good way for us to observe our children’s eating habits. If anything becomes suspicious, we can act quickly!
In my next newsletter, I will focus on treatment and what we should be doing if we realise that our children are not taking good care of themselves in regard to their eating habits.
If you wish to read further on this topic:
Icard M., 14 Talks by Age 14, The Essential Conversations You Need To Have with Your Kids Before They Start High School, 2021, Random House, NY
Natterson C., Kroll Bennett V., This Is So Awkward, 2023, Random House, NY
National Eating Disorders Association
Hildebrandt Laboratory: Icahn School of Medicine at Mount SInai
Raising Good Humans Podcast by Dr Aliza Pressman: How to Prevent Eating Disorders and Disordered Eating with Dr Tom Hildebrandt (Spotify)