12

A Background on Eating Disorders

Eating disorders (EDs) are mental illnesses that are defined as “serious and sometimes fatal illnesses that cause severe disturbances to a person’s eating behaviors” (National Institute of Mental Health, 2017). According to the National Institute of Mental Health (2017), 2.7% of adolescents experience an eating disorder, and females are more than twice as likely to develop an eating disorder than males. The most common types of EDs in children are binge-eating disorder, anorexia nervosa, and bulimia nervosa, in that order, with anorexia nervosa being the deadliest condition (Farrar, 2014). Learning about the impact of parents and peers can develop an understanding of how to treat and prevent them.

“Four Ways a Family Enables Someone with an ED,” by FINDINGbalance is licensed under CC BY-ND 3.0.

A parent is one of the most direct influences in their child’s life, especially during the adolescent years – a time when children and teens are especially likely to develop eating disorders. Children learn lots of information from observing what is around them, including the behavior of their parents, who are often unaware of exactly how much their actions can be understood and mimicked by children. Eating disorders are on the rise in younger children and teenagers, so it is especially important to note how parents might display their own relationship with food and body image, and how it impacts their children. One survey by the National Eating Disorders Association revealed that 80% of 10-year-olds are afraid of being overweight. Many adolescents, mainly girls, report that their body image problems come from a belief that their mothers want them to be thin. Boys also experience this issue with 18% saying they are “extremely concerned” about their bodies, according to the Harvard School of Public Health (Glatter, 2014). Children learn their morals, behaviors, and many other aspects of their identity from their parents. Some of these will be related to food and body image, and they play important roles in the development of eating disorders, so it is important that parents are aware of how they act as role models, and how they can support their children.

Family Life and Eating Disorders

Parental qualities of warmth, involvement, and disciplinary actions that are supportive rather than offensive tend to be the most effective for raising healthy children and limiting the development of eating disorders. Children who display better relationships with their mothers exhibit better coping mechanisms, tend to be healthier, and at lower risk for developing eating disorders (Garcia et al., 2019). Positive family relationships and reduced family conflict also contribute to overall well-being (Cance et al., 2014). As a result, it is important for parents to build strong, positive family relationships not only to prevent eating disorders, but to create an overall healthy and safe home environment for their children.

Alternatively, parents who exhibit neglectful, overprotective, or over-controlling traits pose an increased risk of eating disorders in their children (Lobera et al., 2011). Over-controlling parenting has been repeatedly linked to disordered eating patterns, including eating too little or eating too much, as a way that many children attempt to regain a sense of self-control (Ekern, 2015). Many parents claim that they do not want their child to gain weight and become unhealthy, however, researchers have found that too much control by parents with regard to eating backfires and may result in their child actually gaining more weight.

The Impact of Parent Behaviors: Words and Actions

The influence of parents on eating disorder development is not limited to parenting styles. Parents who themselves have symptoms of eating disorders are more likely to have children who develop similar disorders, which can be attributed to excess control that these parents exert over-eating habits (Blissett & Haycraft, 2011). Parents may engage in what is called “emotional feeding,” which is when they feed children who are in a bad mood with the intention of soothing. When this happens, children begin to think that negative emotions can be fixed by eating foods, so they begin to engage in “emotional eating,” which is when they eat to cope with negative emotions. Along with emotional feeding, parents themselves can model emotional eating. When parents do this, their children can begin to think that these behaviors are normal and acceptable. This can lead to obesity and binge-eating disorder in children as they use food to cope with stressors (Christensen, 2019). Other problematic actions taken by parents include complaining about their own weight or diet, using the word “fat” as an insult, and labeling foods as “good” and “bad” (Did My Mom Cause My Eating Disorder, 2019). These behaviors might seem harmless, however, there are serious consequences when a child begins to view food and bodies this way.

Unfortunately, even if parents only talk negatively about themselves, this still affects their children who are learning from their parents’ behavior. For example, one study revealed that verbal influence (defined as commenting on weight), as well as modeling unhealthy attitudes towards eating by parents, were both related to disordered eating in children, with the verbal comments being the most harmful. Experiencing this verbal influence was associated with being overweight or obese, which shows how these types of “preventative” comments and behaviors are ineffective at promoting a healthy lifestyle (Abraczinskas et al., 2012). A similar study on mothers and daughters found that mothers commenting on either their own weight or their daughters’ weight was associated with disordered eating, unhealthy weight control behaviors, and symptoms of depression. None of the weight-related comments lead to healthy weight management practices by the daughters (Bauer et al., 2013). Alternatively, the study found, conversations that focus on healthy eating rather than weight can actually protect children from developing eating disorders and other negative eating behaviors (Berge et al., 2013). Parents who model and encourage positive behaviors can raise healthier children.

“Role of a Mother in Daughter’s Body Image,” by FINDINGalance is licensed under CC BY-ND 3.0.

The attitudes and behaviors of parents significantly contribute to the onset of eating disorders. Parents need to take the initiative to become more educated about these effects. By becoming more educated, they can help create a safer and healthier society for their children.

Peer Influence

Children interact with their peers on a daily basis during school, sports, and many other activities. Due to the time spent with their peers, children tend to develop the same behaviors as their friends, and the way they are treated by their peers can influence their behaviors.

A major concern that surrounds school systems is bullying, which is using aggressive or intimidating behavior to physically, mentally, or emotionally harm another person. There is a relationship between childhood bullying and poor health as an adult (DeLara, 2018). The results from a study found that people who had been bullied as children showed more signs of body shame and dissatisfaction, leading to higher rates of eating disorders in adulthood (DeLara, 2018). Experiencing bullying causes one to develop negative feelings about themselves, which can eventually lead to the development of eating disorders.

Daily interactions with peers also influence developing EDs, as children try to fit into certain groups (Al-sheyab et al., 2018). This powerful desire to fit in often causes changes in thoughts and behaviors, which can contribute to eating disorders if children think they have to look a certain way to become popular among their peers. A survey of 13-16 year-olds found that peer pressure and a desire for popularity are major influences in the development of EDs (Al-sheyab et al., 2018). Interestingly, it was found that people who report being well-liked by their classmates may be more likely to have an eating disorder in the future (Smink et al., 2018). It is common to find that popular students may have adopted disordered behaviors in order to feel more likable.

A study in Fiji supported that peers influence body image concerns and that perceived peer norms can influence the onset of eating disorders (Gerbasi et al., 2014). For example, if a girl believes that her friends think being thin is normal and good, then she may take extreme measures to fit that image.

Peers and parents play a role in the onset of eating disorders, but these, among other mental illnesses, can be made more preventable by prioritizing awareness and education.

What can be done to help?

While many complicated factors play into the development of an eating disorder, the quality of a child’s home life is the basis for how they manage their mental health. Parents need to actively create a supportive family environment, along with staying aware of their own body image and attitudes about food in order to promote the health of their children.

Here are some helpful suggestions to consider:

The following are ways to help limit peer influence in eating disorders:

Educating the youth and their parents is important for preventing eating disorders. By increasing awareness of these contributing factors, the hope is that a more accepting environment can be created, which will aid children in growing up happy and healthy.

Additional Resources

Children and adolescents who are suffering from disordered eating, bullying, acting as bullies, or any other emotional distress could be candidates for therapy or counseling treatments. There may be counseling services offered through schools and other community institutions, however, contacting a primary care physician or pediatrician is a good place to start voicing concerns and seeking treatment.

Here are some helpful websites with more information about specific eating disorders, symptoms, treatments, and family resources:

National Eating Disorder Association (NEDA): https://www.nationaleatingdisorders.org/

NEDA Helpline: (800) 931-2237

Eating Disorder Hope: https://www.eatingdisorderhope.com/

Families Empowered And Supporting Treatment for Eating Disorders (FEAST): https://www.feast-ed.org/

Summary

Eating disorders are life-threatening illnesses that require lots of support to recover from. It is the responsibility of parents to encourage a good body image, healthy eating habits, and acceptance of others in order to help prevent the onset of disordered eating. It can be difficult to know where to start when making changes, but a little effort goes a long way along with education and awareness of these issues (see infographic below for a summary of this information).

References

Abraczinskas, M., Fisak, B., & Barnes, R.D. (2012). The relation between parental influence, body image, and eating behaviors in a nonclinical female sample. Body Image, (9)1, 93-100. https://doi.org/10.1016/j.bodyim.2011.10.005

Bauer, K.W., Bucchianeri, M.M., & Neumark-Sztainer, D. (2013). Mother-reported parental weight talk and adolescent girls’ emotional health, weight control attempts, and disordered eating behaviors. Journal of Eating Disorders, 1(45). https://doi.org/10.1186/2050-2974-1-45

Al-Sheyab, N. A., Gharaibeh, T., & Kheirallah, K. (2018). Relationship between peer pressure and risk of eating disorders among adolescents in Jordan. Journal of Obesity, 2018, 1–8. https://doi.org/10.1155/2018/7309878

Berge, J.M., MacLehose, R., Loth, K.A., Eisenberg, M.E., Buchhianeri, M.M., & Nuemark-Sztainer, D. (2013). Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA Pediatrics, 167(8), 746-753. https://doi.org/10.1001/jamapediatrics.2013.78

Blissett, J. & Haycraft, E. (2011). Parental eating disorder symptoms and observations of mealtime interactions with children. Journal of Psychometric Research, 70(4), 368-371. https://doi.org/10.1016/j.jpsychores.2010.07.006

Did my mom cause my eating disorder? Six ways parents unintentionally teach disordered eating to their children. (2019, October 21). Center for Discovery. https://centerfordiscovery.com/blog/mom-cause-eating-disorder-six-ways-parents-unintentionally-teach-disordered-eating-children/

Cance, J. D., Loukas, A., & Talley, A. E. (2014). The differential associations of internalizing symptoms and family and school relationships with disordered eating attitudes among early adolescents. Journal of Social and Personal Relationships, 32(1), 41–56. https://doi.org/10.1177/0265407514523551

Christensen, K. A. (2019). Emotional feeding as interpersonal emotion regulation: A developmental risk factor for binge‐eating behaviors. International Journal of Eating Disorders, 52(5), 515–519. https://doi.org/10.1002/eat.23044

Cortés‐García, L., Hoffmann, S., Warschburger, P., & Senra, C. (2019). Exploring the reciprocal relationships between adolescents’ perceptions of parental and peer attachment and disordered eating: A multiwave cross‐lagged panel analysis. International Journal of Eating Disorders, 52(8), 924–934. https://doi.org/10.1002/eat.23086

DeLara, E. W. (2019). Consequences of childhood bullying on mental health and relationships for young adults. Journal of Child and Family Studies, 28(9), 2631–2631. https://doi.org/10.1007/s10826-019-01515-4

Ekern, J. (2015, March 23). Parents’ perceptions towards food can influence child’s eating habits. Eating Disorder Hope. https://www.eatingdisorderhope.com/blog/parents-pressure-of-children-eating-habits-may-create-eating-disorders

Farrar, T. (2014, May). Eating disorders statistics. Mirror mirror. https://www.mirror-mirror.org/eating-disorders-statistics.htm

Gerbasi, M. E., Richards, L. K., Thomas, J. J., Agnew-Blais, J. C., Thompson-Brenner, H., Gilman, S. E., & Becker, A. E. (2014). Globalization and eating disorder risk: peer influence, perceived social norms, and adolescent disordered eating in Fiji. International Journal of Eating Disorders, 47(7), 727–737. https://doi.org/10.1002/eat.22349

Glatter, R. (2014, February 22). National eating disorders week: how parental behavior may impact a child’s body image. Forbes. https://www.forbes.com/sites/robertglatter/2014/02/22/national-eating-disorders-week-how-parental-behavior-may-impact-a-childs-body-image/#1bb20f0944e5

Lobera, I. J., Ríos, P. B., & Casals, O. G. (2011). Parenting styles and eating disorders. Journal of Psychiatric and Mental Health Nursing, 18(8), 728–735. https://doi.org/10.1111/j.1365-2850.2011.01723.x

Lyness, D. A. (Ed.). (2013, July). Helping Kids Deal With Bullies (for Parents). Nemours KidsHealth. https://kidshealth.org/en/parents/bullies.html

National Institute of Mental Health. (2017, November). Eating disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml

Smink, F., van Hoeken, D., Dijkstra, J. K., Deen, M., Oldehinkel, A. J., & Hoek, H. (2018). Self‐esteem and peer‐perceived social status in early adolescence and prediction of eating pathology in young adulthood. International Journal of Eating Disorders, 51(8). https://doi.org/10.1002/eat.22875

Stop Bullying. (2017, September 29). What you can do. Stop Bullying. https://www.stopbullying.gov/resources/what-you-can-do