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Raising a teenager with an eating disorder in a pandemic

Many people have already written about the difficulties we’re having in the midst of COVID-19 – they are numerous and far-reaching, some as insidious as the disease itself. As researchers and clinicians in the field of eating disorders, we are now challenged to consider how we can best help those who are quarantined with a loved one experiencing symptoms of an eating problem. But for the family of a young person with an eating disorder, there are some specific concerns worth addressing.

First, families need to make sure underweight teens are eating enough. Family meals, in which support is provided by the household, are a mainstay of Family Based Therapy, the treatment approach of choice for many teens in need of weight restoration. In this therapy, parents take charge of meal planning, preparation, and supervision, until they can hand responsibility back to the teen. While this typically represents a big change from normal for teens, during these unusual pandemic times, families are eating more meals together than ever before. This may help make the process just a little easier. Because intake needs tend to be high to achieve renourishment, it is important for parents to have a stock of calorically dense foods in the pantry or fridge. To counteract the rigidity and stereotyped eating behavior characteristic of restrictive-type disorders, it’s critical to frequently include challenging foods. Parents can talk with their children about what is most helpful during mealtimes – maybe it’s cheerleading with encouragement or reminding them how important to their goals in sports or in school eating well and getting better is.

Families should also minimize the risk of binge eating. Parents may wonder, “if we are in the house so much now, should we get rid of foods that will tempt my teen to overdo it?” The truth is that binge eating is less about the food being eaten during the loss-of-control moment than it is a reflection of someone’s overall eating pattern, or a reaction to stressors (like feeling sad or anxious, or fighting with a friend or sibling) or circumstance (such as eating while watching Netflix or having constant, easy access to the kitchen). For these reasons, it’s more helpful to promote sticking with a pattern of eating regular meals and snacks, with a balance of nutritious, tasty foods. Parents can model non-eating-related coping strategies when feeling stressed, such as taking a walk, listening to upbeat music, or talking about it with someone. Parents can also initiate an activity and encourage a teen to join if it’s clear that he or she is having a hard time. Portioning food from large bags or serving containers in advance, having snack-size items on hand, and encouraging eating to happen at a table (rather than on the sofa) can also help minimize the chance of mindless overeating.

Additionally, it is important to be aware of body image concerns. The pandemic lifestyle may  lead to people feeling worse about how they look, exacerbating a negative body image. For example, it’s more tempting to dress down when socially distancing, and there may be fewer opportunities to get out and be active depending on the summer heat and humidity.

Research has shown that the amount of time spent on social media, especially in curating an online persona or posting selfies, is negatively associated with body image, and disordered eating attitudes and behaviors. In addition, some people with eating disorders describe difficulty inhibiting self-scrutiny as they are repeatedly confronted with their image while on Zoom or FaceTime. Parents should talk with their teenagers to determine if they’d like to work treating the experiences on social media or video chat platforms like exposures, leaning into the discomfort, or if they’d prefer to adjust video settings to minimize their image until they are ready to take on an exposure mindset. It’s also important to look for occasions for all family members to dress up to encourage variety in clothing choices. Unconditional body positivity need not be the goal – for most of us, body neutral is the place to aim. 

Just how much to talk about the eating disorder is a common problem for parents supporting children through recovery. And given the restrictions placed on us currently, parents might be noticing a lot and feel tempted to point out every concern. It is important to flag troublesome, observable behaviors, and to clearly communicate expectations around particular goals – be it completing a meal, varying exercise routines, or trying a new food. However, these conversations are sometimes best had at a calm moment outside of mealtime. And it is equally important to continue to talk to teens about other topics – for example, popular shows, the latest goings on in a friend group, or reactions to current events in the world. Part of moving beyond an eating problem is developing and investing in other aspects of identity; this can be cultivated in conversation that reminds a teen subtly that a parent knows that the teenage is not their eating disorder. He or she is so much more.

Coping with the COVID pandemic is challenging for all of us on many levels. This is equally or more true for parents of a youngster with an eating disorder. Although the basic strategies for helping do not change, there may be new opportunities to implement them and new situations to grapple with. And it is possible that increased time together as a family may yield some surprising benefits.

Featured Image Credit: Image by prostooleh via Freepik.

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