Deciding whether therapy is the best option for your child can feel complicated for many reasons. Maybe you’ve noticed changes in your child’s behavior. Or perhaps a friend, family member, teacher, or healthcare provider has raised a concern. Whatever the case may be, it’s understandable if you feel unsure, overwhelmed, and/or emotional.

First of all, all of your feelings are normal and valid. Second of all, there are steps to get grounded and gain more clarity. While this isn’t a complete list, it may be a helpful place to start. 

Steps to figuring out if therapy is right for your child: 

1. Know what to look out for 
2. Educate yourself about the benefits of therapy 
3. Establish your support system

Let’s break down each step. 

What to look out for

As with other behaviors, disordered eating can be difficult to see if you don’t know what to look for. Start by noticing your child’s eating habits, mental and emotional state, and/or physical wellbeing.

Shifts in eating habits could include:

• Restrictive eating
• Binge eating/Eating when they are full
• Use of laxatives, vomiting, or excessive exercise after eating
• Eating alone
• Lack of appetite or interest in food

Changes in mental and emotional state could include: 

• Nonstop pursuit of thinness, fear of gaining weight
• Unwillingness to maintain healthy body weight 
• Distorted body image
• Seeing their value as solely driven by body size/shape
• Feeling distressed, ashamed, or guilty about food consumption

Shifts in physical well-being could include: 

• Dramatic weight loss or gain
• Brittle hair and nails 
• Dry skin, dull hair
• Severe constipation 
• Lethargy, sluggishness, and feeling tired all the time 
• Stomach discomfort 

The signs and symptoms listed above could point to an eating disorder. If you’re noticing a shift in one of these areas but not another, it’s still a good idea to speak with a professional. For example, those in bigger bodies suffering from eating disorders often fly under the radar because of the bias that only those in very thin bodies experience disordered eating.

All of this can be very difficult to think about, but know that there are many ways to support your child and early intervention is safest and most effective. 

Educate yourself about therapy

Therapy is proven to be very effective for addressing body image concerns. Therapists are an important part of the team children need to work with if they are experiencing disordered eating habits, or have been diagnosed with an eating disorder. A therapist can help your child identify what issues are influencing their relationship with their own body and food. Then they can recommend how to provide support. 

There are many kinds of effective therapies for eating disorders. Some of the most popular include: 

• One-on-one cognitive behavioral therapy
• Group cognitive behavioral therapy
• Family-based therapy

It’s important to know that treating an eating disorder requires a team of experts, including you as the parent. Being a safe, non-judgemental space for your child to come to is so important. In addition to your support, the pediatrician and a therapist, you may need to work with a dietitian familiar with eating disorder recovery and in some cases, hospitalization or intensive outpatient therapy may be most beneficial. 

Lean on your support system

As you move through this process, it’s very important to have your own support network. Friends, family members, and even a therapist of your own can help you stay grounded. You might also consider joining a support group so you can learn what’s worked for other families. Whatever the support looks like, remember you aren’t alone and there absolutely is a path forward. 

If you still have questions, talk to your pediatrician and/or use the National Eating Disorders (NEDA) screening tool.

Reviewed by the Ovia Health Clinical Team

Related topics

• How to talk to your pediatrician about weight inclusive care
• How family meals can benefit your child’s relationship with food
• Body confident parenting
• How your beliefs about food impact your parenting
• How to raise body confident kids

Sources

1. “Eating Disorders.” National Institute of Mental Health. National Institute of Mental Health. January, 2023. https://www.nimh.nih.gov/health/topics/eating-disorders
2. “Eating Disorder Screening Tool.” National Eating Disorders. National Eating Disorders Staff. 2022. https://www.nationaleatingdisorders.org/screening-tool
3. “Eating disorder treatment: Know your options.” Mayo Clinic. Mayo Clinic Staff. July 14, 2017. https://www.mayoclinic.org/diseases-conditions/eating-disorders/in-depth/eating-disorder-treatment/art-20046234
4. Hornberger, LL. “Identification and Management of Eating Disorders in Children and Adolescents.” American Academy of Pediatrics. 147(1). Web. January 2021. 
5. “Therapy to Improve Children’s Mental Health.” Center for Disease Control and Prevention. Center for Disease Control and Prevention. April 19, 2022. https://www.cdc.gov/childrensmentalhealth/parent-behavior-therapy.html
6. Laurie L. Hornberger, Margo A. Lane, THE COMMITTEE ON ADOLESCENCE, Laurie L. Hornberger, Margo Lane, Cora C. Breuner, Elizabeth M. Alderman, Laura K. Grubb, Makia Powers, Krishna Kumari Upadhya, Stephenie B. Wallace, Laurie L. Hornberger, Margo Lane, MD FRCPC, Meredith Loveless, Seema Menon, Lauren Zapata, Liwei Hua, Karen Smith, James Baumberger; Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics January 2021; 147 (1): e2020040279. 10.1542/peds.2020-040279. https://publications.aap.org/pediatrics/article/147/1/e2020040279/33504/Identification-and-Management-of-Eating-Disorders?autologincheck=redirected

Research shows that adolescents who eat family dinner some or most days were less likely to develop disordered eating habits, purge, binge, or diet restrictively. 

Family meals are beneficial because they: 

• Create a safe environment free of judgment or pressure
• Allow you to teach your child to listen to their body.
• Give you a chance to become their role model around eating and food.

Let’s dive into the steps to take to experience the benefits of family meals. 

How to create a safe environment

A child who struggles with their body image may view food as unsafe, scary and/or something to restrict. Family meals create a space to frame food differently. A lot of the reframing can happen by simply changing your language. Here are some examples:

Another big point to remember is that food is often labeled as “good” or “bad.” Modeling the idea that all food has value, and avoiding labels like good, bad and junk – can set a less judgmental tone. 

Family meals also offer a natural pause in the day and your undivided attention. It should be a tech-free zone for each member of the family. This is important because it can be difficult for your child to bring up deep feelings when you’re busy or when anyone is distracted by a device. Mealtime can create space for your child to share any of their struggles with food or other areas of concern. This environment also allows you to ask questions, give support, and check in with your child along the way. 

How to teach your child to listen to their body

Our fast-paced culture can prevent us from listening to our bodies. This may make it difficult to know when, how much, and what to eat. A child who struggles with disordered eating may already feel detached from their body. This makes it even harder to establish a healthy relationship with food.

Family meals give you the opportunity to help your child pay attention to feelings of hunger and fullness. Meals should be a no-pressure zone where they feel free to eat as much or as little as they want. They should also feel comfortable to eat food in any order they wish, for example they don’t need to eat vegetables first or get a dessert reward for clearing their plate. Meals that are served family-style allow your child a little bit more control over this process. Learning  about hunger cues not only gives them agency over their own body, but it also provides them with tools to be more independent. Other benefits of your child learning how to listen to their bodies include: 

• Knowing when it’s time to eat 
• Knowing when it’s time to stop eating  
• Learning what they like or dislike 
• Slowing down 

How to be your child’s role model

You have more influence over your child’s relationship with food than you think. Even seemingly subtle remarks and/or behaviors could make a big difference. 

The first step to being a good role model for your child is embodying the beliefs yourself. To start, you can answer these questions for yourself:

1. Do you think about food in the context of calories, weight gain, and/or physical appearance? 
2. Is food often a reward or something you have to earn by exercising?
3. How can you reframe food as nourishing, refueling, and strengthening?
4. What might you need to slow down and listen to your body?

Gaining clarity around your own relationship with food can allow you to teach your child to do the same. Remember, your child likely looks to you for guidance. You’re empowered to help them strengthen their relationship with food, starting with family meals. 

Reviewed by the Ovia Health Clinical Team

Related topics: 

• How to talk about weight-inclusive care with your pediatrician
• When is time for your child to talk to a therapist about disordered eating?
• Delicious dinners for the whole family
• How your beliefs about food impact your parenting
• Food for the holidays: A winning approach

Sources: 

1. “Bulimia nervosa.” Mayo Clinic. Mayo Clinic Staff. May 10, 2018. https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615
2. Haines, J. “Family dinner and disordered eating.” National Library of Medicine. 18 (1): 10-24. Web. Jan 1 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856109/

What is weight-inclusive care?

Weight-inclusive care emphasizes health as the ultimate outcome while also acknowledging that factors contributing to health are varied and complicated. Health is a continuum with many possible outcomes and possibilities. Weight-inclusive care also aims to improve access to unbiased healthcare and reduce weight stigma experienced by those in larger bodies. 

Some examples of weight-inclusive care include focusing on:

• Health Promoting Behaviors rather than changing the number on the scale
• Overall wellness instead using BMI
• Setting SMART goals to address modifiable risk factors for individuals 

Weight-inclusive care is still a relatively new approach in the medical field. It makes sense if this is the first time you’re discussing it with your pediatrician. The good news is that you’re in the driver’s seat – you get to control how to approach and continue the conversation, and you don’t have to settle for biased care. 

What’s the best approach?

Weight-inclusive care is a broad topic, so your approach will depend on lots of factors. These could include your child’s health background, your communication style, and/or your relationship with your pediatric provider. And, while there isn’t one “best” approach, here are some ideas to get you started:

1. Plan ahead

Because these conversations can be draining, it may help to have a plan beforehand. You can start by asking yourself questions including:

• What is my goal in having this conversation?
• What is my definition of weight inclusive care? 
• In a perfect world, how would I like to see the provider using this method?
• What are some examples of weight exclusive care?
• What will I do if the pediatric provider isn’t as receptive as I’d hoped?
• What will the next steps be after the conversation?
  

2. Bring evidence to the conversation.  

Whether or not your pediatrician is knowledgeable about weight-inclusive care, you’ll want to highlight its importance. If you’re not quite sure how to start the conversation, that’s okay! You can do this in-person, or via phone or messaging if you have access to that. Some people even write down their concerns the old-fashioned way, and give their provider’s office a hand-written note. Here are some good talking points from the Centers for Disease Control and Prevention:

• Healthy at Every Size movement: Health at any weight. 
• The harms of stigmatizing weight: Shame is not an effective motivator, decreases desire to seek medical attention, and causes a strained provider-patient relationship. 
• The benefits of weight-inclusive care: Empowering the patient, effectively achieving health goals, and building a strong patient-provider relationship.

3. Provide specific examples.

Examples of the kind of care you’re seeking can help you and your pediatrician get on the same page. Concrete direction can also prevent or at least decrease confusion later. Some examples you might give are:

• Not weighing your child or discussing weight/size unless medically necessary
• Not discussing BMI, as it Isn’t a measure of health
• Encouraging movement instead of discouraging stillness
• Assessing stress, sleep, and other health promoting behaviors

What should I do next?

After you’ve had the conversation, keep checking in to make sure your pediatrician is honoring your request. Here’s how: 

• Observe how your pediatrician interacts with your child in the office
• Ask your child how they feel about their care after they’ve had a visit
• Check in with your pediatrician regularly

Remember, you’re empowered to start and continue this conversation in whatever way you feel is right for you and your family.

Reviewed by the Ovia Health Clinical Team

Related topics

• When is time for your child to talk to a therapist about disordered eating?
• How family meals can benefit your child’s relationship with food
• Body confident parenting
• How your beliefs about food impact your parenting
• How to raise body confident kids

Sources

1. “Center for Disease Control and Prevention” homepage. Center for Disease Control and Prevention. https://www.cdc.gov/
2. Dollar, E. “Do No Harm: Moving Beyond Weight Loss to Emphasize Physical Activity at Every Size.” Centers for Disease Control and Prevention. Preventing Chronic Disease. April 20, 2017. https://www.cdc.gov/pcd/issues/2017/17_0006.htm 
3. Humphreys, S. “The unethical use of BMI in contemporary general practice.” National Library of Medicine. 60(578): 696–697. Web. September 1, 2010.
4. Tylka, T. “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss.” National Library of Medicine. 2014; 2014: 983495. Web. July 23, 2014.