Teens and Eating Disorders with Danielle Swimm
We know that the onset of eating disorders very typically begins in the teenage years and that teens are particularly vulnerable to disordered eating… so how can we create an environment that fosters a healthy relationship with food and body for teens?
Whether you are a teen, have a teen, or just want to understand your teenage self, Danielle Swimm, LCPC, provides enlightening answers for us.
Danielle is a good friend of mine and is a certified eating disorder specialist in Annapolis, Maryland. She has a group practice, Collide Behavioral Health, that focuses on helping women heal their relationship with food and their body.
She’s really into mental health and female empowerment, and she’s a business coach for therapists – which is the coolest! When she’s not working, she’s doing yoga or outside with her toddler and puppy (and her puppy is pretty adorable!).
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It's really important to talk about this stuff because so often teens are left struggling without getting help. But when we do have someone who reaches out for help sooner, recovery is so much more likely.
What we’ve noticed is that over the pandemic, the amount of inquiries – especially for teens – skyrocketed. Danielle has a few insights on why that may be and she’s sharing them with us. We talk about teens and eating disorders, how the pandemic exacerbated it, and how to approach conversations with teens around food and body image. Let’s just jump right in!
Why Eating Disorder Affect Teens More
The body of a teenager is constantly changing. They’re becoming very aware of what other people think of them; they’re suddenly aware of the way they look and how others look at them. Anxiety and depression can be high, sex hormones are raging, and so they often look to the one thing they can control: food and their body.
Personal note: when I was a teen, I remember a talk that was given about how our bodies change, and there was a piece that this person highlighted about how “you can’t eat what you want anymore because your body isn’t just growing a few inches every year.” My current self says, “Seriously?!” But back then, it really stuck out in my head– when I was 12, almost every weekend was a bat mitzvah, and I remember my heightened awareness of how much pasta I was eating.
Isn’t that crazy?!
Danielle’s heard parents and doctors parrot this idea to teens, too: “You’re no longer a kid. Your metabolism will catch up with you now.” All this pressure is put on them about how their body is changing and they have to be careful about what they’re putting into their bodies.
A perfect storm for disordered eating. Hooray. 🙄
How the Pandemic Changed Everything
Danielle says the pandemic’s effect on eating disorder rates was like gasoline thrown onto a fire.
She said it was really quiet initially during lockdown… and then, about 6 months after March 2020, there was a boom. 2021 was a huge, overwhelming burst of eating disorders into her practice.
She got curious about the “why” behind this. She feels like we’re not far enough out yet to know the complete why behind it, but we do know enough. She cites an article from Forbes that interviewed a couple of adolescents who developed eating disorders during the pandemic.
What they found is that what a lot of adults weren’t seeing is what the teens were seeing on social media. There were challenges on TikTok and Instagram to “not gain the COVID 15,” involving extreme “clean eating” and exercises. For the first time ever, teens were only socializing through their phone because they couldn’t leave their house.
The Effects of Social Media
Social media has changed – there are all of these challenges around body image and food, and the influencers doing it have these unattainable bodies for most people. So the world was experiencing a traumatic event, and then teens were constantly being exposed to these messages – and the teens picked up on this and ran with it.
Parents were overwhelmed, understandably, and were often allowing more screen time than normal. They would see their teens doing an ab challenge or making “healthier choices,” so it was easy to miss… until it snowballed into a full-blown eating disorder.
Throw in what they were seeing on the news, and the fear they had that their grandparents or parents were going to die from COVID, or thinking they needed to lose weight to avoid COVID… and controlling your food and body was likely a very welcome distraction to many adolescents.
“How do I help my teen be healthy without enabling an eating disorder?”
That’s a huge question as a parent of a teen, right? You want your teen to thrive and be healthy, but of course you don’t want your words and attitude around food and their bodies to contribute to the development of an eating disorder.
Danielle encourages taking a holistic view of health. Instead of focusing on what they are eating, try asking: How is their emotional health? How are they physically feeling?
Parents who want their teen to be healthy often comment on the cookies or junk food they eat, and suggest cutting out “fun foods” altogether. But a helpful fact Danielle tells these parents is that a teen is 242 times more likely to develop an eating disorder over type 2 diabetes. Can you believe that?!
Meaning, when your child is eating a cookie and you’re worried about their health, the likelihood of that cookie (or many cookie eating sessions) doing damage is significantly lower than telling them they shouldn’t eat it.
Instead ask them: “How are you feeling? Did you get enough to eat?” and view food as energy, rather than something to be controlled or used as punishment.
Danielle mentions the book How to Raise an Intuitive Eater for parents (I even have a podcast episode where we talk about it!). There are awesome tips parents can learn from this book, like how to talk to your child, and how you can pair certain foods together for more energy and fuel… but a lot of the child’s health comes from what you’re modeling in your relationship with food (and yes, I know, that’s a hard pill to swallow sometimes!).
“My teen is gaining weight… what do I do?”
First, let’s normalize that bodies are constantly changing during this age. They are gaining weight, and that’s completely normal.
The question for parents is, what can you do to help build up their body image? They are going to have changes in their body – that’s normal. What can you as their parent do to help them be emotionally resilient enough to handle that, while making sure they take care of their holistic health?
It’s an extremely difficult task, because it’s counter-cultural. But if a doctor suggests that a teen start cutting out food to lose weight and their parent wants to follow that, Danielle suggests asking some questions before they do so:
Is it sustainable?
What is that going to do to their relationship with food? To their mental health?
What happens if they don’t follow that? Will they feel guilty and anxious about eating that food? Will they feel like they’re disappointing you?
Will binge eating start happening because they’re restricting?
Danielle notes that the recommendation of weight loss sounds fantastic – but it’s important to be realistic and to look at other options with Health at Every Size in mind to ensure a child’s holistic health.
My own thoughts? It’s so important to look at it through this perspective because teens’ bodies will continue to change for the rest of their lives. Think about teen girls. Many of them will get pregnant at least once during their lifetime. Every woman will experience menopause at some point as she gets older. These are times when a woman’s body will change drastically and it’s supposed to. We all need the skills and capacity to navigate body changes, let’s lay the foundation now. Chances are, the way that someone responds to their body changes during puberty, significantly informs how they will respond later on in life.
How to Talk to Your Teen
We talk about how our hunger-fullness cues are there when we’re born – and then part of how it’s stripped away is exposure to culture that emphasizes external cues as opposed to tuning into internal cues.
So as the parent, we don’t want to play a part in messing with hunger-fullness cues, because it’s so much work to get them back (it’s worth it! But we want to preserve it from the beginning).
So what if you’re a parent, and you start to notice your teen is commenting on how fat they are, critiquing themself in the mirror a lot, etc.?
Danielle says although the temptation is to immediately reassure them that they’re not fat (or big, or whatever), they should instead consider asking them, “What’s going on here? I’ve noticed you’ve said this a couple of times.”
Danielle says a lot of teens have told her that it actually doesn’t help when people tell them they’re not fat. It either invalidates their perspective or it makes them feel like, “But what if I am fat? Are you saying that’s not okay?” But if parents can open up the dialogue in a different way, that’s the first step.
The second step is looking at your own body image and relationship with food. Is it one you want to be modeling for your teen? (As an aside, this is probably the hardest part. It’s so much easier to get a list of what to do or say. It’s another ballpark to hold the mirror up to our own face and ask how we can change our innermost self.)
The third step is having positive conversations with your teen about the body’s functions. Meaning, you can say “Make sure you eat a good breakfast today – you have a lot of tests, and your brain needs nourishment.” Or “You were at soccer practice for 4 hours today – I bet your legs are getting really strong.”
Danielle also notes that seeing a body image therapist can be life-saving because disordered eating very often starts with body image.
The bottom line? Teens are really good at being secretive. So if a teen is making comments or doing things in front of you, they want you to notice. They are waving a flag to say they need some attention in this area. Your teen will likely be really happy to talk to someone – whether it’s you or a therapist – about what’s going on in their head.
And if you don’t have the best relationship with your teen? Danielle has seen that the teens who pull away can actually be really open about body image if they’re making comments about it. When in doubt, just approach it in a really authentic way. Even if they respond in a combative way, you’ve done a great job – because they now know they can come back to you to talk about this…. And many of them do.
Tweetable Quotes
“You’re trying to set your kid up for a healthy relationship with food… for their entire life. Today, they’re 13, 14, 17… but their body’s going to continue to change in 10, 20, and 40 years… especially for girls when they’re women, and they go through pregnancy and menopause – you have to have these skills, because otherwise, you’re totally screwed.” – Rachelle Heinemann
“In our culture, that isn’t talked about. It’s just assumed you go through puberty and your body stays the same for 50 years. It’s not accurate at all, and it’s very unattainable. The body isn’t meant to do that.” – Danielle Swimm
“If [a teen] is making comments [about their body], they’re asking for help. They want you to know. They’re not going to say things to you that they don’t want you to know – teens know how to be very secretive – so if they’re saying something to you or doing something in front of you, they’re waving a flag to say, ‘I need some attention in this area.’” – Danielle Swimm
“If they say, ‘I’m so fat,’ and you say, ‘No, you’re not’ or ‘You’re so beautiful,’ what really you’re saying is, ‘I actually disagree with your perspective’ and that’s really invalidating… or you’re almost saying ‘Yeah, you’re fat, but I also think you’re beautiful.’” – Rachelle Heinemann