Understanding and Addressing Eating Disorders in Youth: A Comprehensive Guide for Professionals

Mental health professional providing empathetic support to female adolescent who appears nervous during a counseling session. Professional has a clipboard in hand and is conducting targeting screening of eating disorder symptoms.

A Comprehensive Guide for Professionals

A 9th grade girl has been referred to the student support team out of concern for a change in affect and appearance. Her homeroom teacher says she has lost a noticeable and concerning amount of weight over the last few months, and lately has been spending most lunch periods in the library instead of the cafeteria. The student continues to earn straight As and is a starter on the varsity volleyball team, but something seems off … and her teachers are worried. 

At 22 years old, the college senior made an appointment with a counselor at his university’s wellness center. He confides to his psychologist that he feels shame. It used to be a pretty normal college thing, he says – eating pizza and drinking beers at parties on the weekends. It always helped him forget the stress he felt about his public speaking class. But what used to feel normal to him has spiraled into a recurring behavior several times a week. And it’s not just a few slices of pizza and a couple of beers anymore. He’s scared he can’t make himself stop. 

The mother of the 10 year old in your office is crying because she can’t get her daughter to eat anything except fruit, toast, and slices of bologna. Her daughter has started to withdraw from their family game nights that they’ve always enjoyed together. She’s acting so … different. The mother is pleading for help to “get her daughter back.” 

Eating disorders are complex. 

They are serious and often fatal psychiatric illnesses that are associated with severe disturbances in a person’s eating behaviors and related thoughts and emotions. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder, all of which involve a preoccupation with food, body weight, and shape. However, the symptoms for each of these disorders present differently. Whether you’re a youth health professional, educator, or parent, recognizing and addressing the signs of eating disorders early can make a profound difference in the outcomes of struggling youth like the ones depicted in this introduction.

In this blog, we cover:

  • The major risk factors associated with eating disorders in youth
  • Current screening recommendations to help with early identification 
  • Recent data and statistics in youth eating disorders
  • Guidance specific to school-based health professionals

Armed with the latest recommendations and research around eating disorders in youth, professionals can play a key role in supporting youth through prevention, early intervention, and ongoing care.

Risk Factors for Eating Disorders in Youth

Understanding the risk factors that contribute to the development of eating disorders in youth is essential for professionals who seek to identify and intervene early. To ground our discussion moving forward, let’s start with a foundational understanding of what eating disorders are and what they are not. 

First, eating disorders are not about food. At least, not really. Food isn’t really what’s at the root of these complex disorders. Rather, eating disorders stem from a complex interplay of genetic, environmental, and psychological factors. 

Psychological Factors

While eating disorders impact youth across all demographics, and each individual youth who is struggling carries their own unique psychological profile, there are some common psychological traits that present across many youth with eating disorders. These include:

  • Perfectionism
  • Low self-esteem 
  • Co-occuring psychiatric disorders

First, youth who exhibit high levels of perfectionism may be more susceptible to eating disorders as they strive for unattainable or unsustainable standards in both physical appearance and performance. The first example story from our introduction might highlight this trait – a high-performing teen earns straight As and starts on a varsity team as a freshman. 

Second, when a youth has a poor self-image or low self-worth, they may be predisposed to developing eating disorders or disordered eating habits as they seek control or validation through their eating habits. 

A third psychological risk factor for the development of eating disorders is the prevalence of another mental illness. In fact, research estimates 55-97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder at some point. According to the National Eating Disorders Coalition, the most common comordibities include “mood disorders (e.g., major depressive disorder), anxiety disorders (e.g., obsessive compulsive disorder, social anxiety disorder), post-traumatic stress disorder (PTSD) and trauma, and substance use disorders.”

Social Factors

Beauty trends have shifted in recent years. The extremely thin models of the 1990s and early 2000s have been replaced with models with bodies of all shapes and sizes, thanks to public health and beauty campaigns like “Love Your Body” that celebrate body positivity. Yet, there are still deeply rooted social, cultural, and economic ties that connect thin women to success. Just last year, The Economist published an article “Can Being Thin Make Women Richer?,” equating economic prosperity and possibility with thinness. The effect of these cultural and social values reaches young girls and teenagers both implicitly and explicitly, and the constant exposure to idealized body images through media can – and does – distort youth perceptions of body image, which increases the risk of disordered eating behaviors.

Peer pressure and bullying are additional social risk factors that increase the likelihood of developing an eating disorder. The desire to fit in or be accepted, especially during adolescence, can lead to unhealthy eating habits as youth attempt to mirror the appearance of their peers. Experiences of bullying, particularly related to weight or body shape, can have a profound impact on eating behaviors and self-esteem for boys and girls. 

Biological Factors

For years, eating disorders were thought to develop as a result of sociocultural factors, only. There is growing evidence to suggest that eating disorders may have a hereditary component, too. This means that individuals with a family history of eating disorders may be more vulnerable. Molecular genetic research of anorexia and bulimia is in its infancy, but initial results support substantial genetic influences on disordered eating. Additional biological factors include changes during puberty – the physical and hormonal changes that occur during puberty can increase stress and anxiety around body image, potentially leading to disordered eating.

Environmental Factors

In addition to psychological, social, and biological factors, eating disorders are influenced by environmental factors like family dynamics and traumatic experiences. Family environments that emphasize weight, appearance, or dieting present greater risks to the development of eating disorders. Trauma, including abuse or loss, may trigger disordered eating as a coping mechanism.

Recognizing these risk factors is the first step in prevention and early intervention. By creating supportive, informed environments, professionals can help mitigate these risks and support youth in developing a healthy relationship with food and their bodies.

Screening Recommendations for Early Identification 

Early identification of eating disorders in youth is critical for effective intervention and recovery. Professionals working with youth—be it in healthcare settings, schools, or community centers—must be equipped with the right tools and knowledge to screen for these disorders. Here are 6 recommended strategies and tools for screening:

1. Know the Signs

Professionals should be familiar with the common signs of eating disorders, which can include changes in weight (either drastic or gradual), preoccupation with weight and food, avoidance of eating in public, withdrawal from social gatherings, and changes in mood or behavior. Keep in mind that many youth with eating disorders “look normal” – if a youth is presenting with extreme weight loss or significant weight gain as a result of eating disorder behavior, it is likely they have been struggling for quite some time. Here’s a quick reference list of symptoms to flag of the 3 most common eating disorders: 

Signs/symptoms of AnorexiaSigns/symptoms of Binge Eating DisorderSigns/symptoms of Bulimia 
  • Reporting an intense fear of gaining weight
  • Preoccupation with body weight, size, and/or shape
  • Calorie counting
  • Declining/ skipping meals
  • Refusing to eat in front of or with others
  • Distorted body image
  • Unusual eating habits
  • Food rules/ avoidance of certain foods
  • Preoccupation with food content/ ingredients
  • Insomnia
  • Irritability
  • Dry skin/hair
  • Extreme weight loss
  • Eating in secret
  • Hiding food
  • Eating beyond fullness or until uncomfortably full
  • Eating at a fast pace
  • Reported feeling of low self-worth
  • Increased depressive symptoms
  • Weight fluctuations
  • Distorted body image
  • Preoccupation with body weight, shape, and/or size
  • Eating in secret
  • Hiding food
  • Eating beyond fullness or until uncomfortably full
  • Unusual eating habits/food rules
  • Expressing shame or guilt around eating
  • Frequently going to the bathroom before, during, or after meals
  • Purchasing or possessing diuretics or laxatives
  • Engage in excessive or compulsive exercise, particularly if exercise continues through fatigue or injury or in inclement weather
  • Drinking excessive amounts of water
  • Scarring on the knuckles from purging

Source: https://www.eatingdisorderhope.com/ 

2. Use Structured Screening Tools

Several validated screening tools are available to help identify eating disorders in youth. The Eating Disorder Examination Questionnaire (EDE-Q) and the SCOFF questionnaire are widely used and can be easily integrated into routine assessments. The comprehensive health technology, ΛDΛM, has been designed to incorporate age- and risk-targeted screening tools for professionals to quickly and accurately identify youth with eating disorder symptoms. The technology supports a multi-disciplinary approach by connecting other data sets, like health and academic (for example) and offers evidence-based brief interventions for professionals. This is especially effective for professionals in school-based settings working alongside multidisciplinary health professionals to determine a comprehensive, intensive treatment plan. 

3. Incorporate Screening into Regular Check-ups

For health professionals, incorporating questions about eating habits and body image into regular health check-ups can help identify potential concerns early. This approach ensures that screening for eating disorders becomes a standard part of adolescent healthcare. Utilizing health technology like ΛDΛM to deliver universal screening that incorporates a trauma-responsive lens ensures no youth goes unnoticed. 

4. Professional Development

Training and development should be top of mind for directors at youth-centric organizations. Equipping all staff to recognize the signs of eating disorders and understand the appropriate steps to take if an eating disorder is suspected requires intentional planning. In K-12 settings, social workers, school nurses, and counselors might consider how to incorporate an in-service on eating disorder risk factors and prevention strategies alongside other high-priority risk areas, like substance abuse or bullying. Training for staff should always include how to approach the topic of eating disorders sensitively. (Hint: asking “Why aren’t you eating?” is not an effective place to start). 

5. Engage in Open Conversations

Creating an environment where youth feel safe to discuss their concerns about food, weight, and body image can encourage them to share their struggles. Professionals should be prepared to engage in open, non-judgmental conversations through motivational interviewing techniques

6. Collaboration with Parents and Caregivers

Involving parents and caregivers in the screening process can provide valuable insights into changes in eating behaviors and attitudes towards food at home. Professionals should work collaboratively with families, providing them with information on how to support their youth’s health and recovery process. Many parents will benefit from explicit instruction and strategies for how to help, and not inadvertently harm, the recovery process. For example, it is not helpful to always talk about food and weight. Instead, parents may benefit from suggestions and prompts for how to connect relationally with their youth, including how to re-establish or strengthen communication. Micro-learning and parenting workshops that provide tangible communication strategies is one great way to support families throughout this process. 

Recent Data and Statistics on Youth Eating Disorders

Eating disorder data highlights both the prevalence and the ongoing need for awareness and intervention. Understanding trends is key for professionals working with young people across different settings, as it underscores the importance of early identification, informed intervention, and comprehensive support systems.

Prevalence Rates of Youth with Eating Disorders 

Recent studies indicate that eating disorders, including anorexia, bulimia, and binge-eating disorder, are on the rise among adolescents. The National Eating Disorders Association (NEDA) reports that eating disorders affect at least 9% of the population worldwide, and the incidence in youth under 12 has been increasing faster than any other age group. The prevalence of youth struggling with disordered eating (but not clinically diagnosable eating disorders) is notably higher. 

Impact of the Pandemic on Youth with Eating Disorders 

The COVID-19 pandemic exacerbated mental health issues among youth, with isolation, stress, and disrupted routines leading to an increase in eating disorder cases. Mental health professionals have reported a significant uptick in referrals and hospital admissions for eating disorders during and following the pandemic period.

Gender and Diversity Considerations for Youth with Eating Disorders 

While eating disorders have traditionally been associated more with females, recent data shows a significant number of males affected as well.  In fact, about 1in 3 people struggling with an eating disorder is male, and “subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.”

Additionally, eating disorders are present across all ethnic and socioeconomic groups, challenging the stereotype that these are conditions only affecting affluent, white females.

Recovery and Mortality Rates in Youth with Eating Disorders 

Eating disorders have one of the highest mortality rates among psychiatric conditions. However, with timely and appropriate intervention, recovery is possible, and the majority of those affected can go on to lead healthy lives.

The data paints a compelling picture of the urgent need for comprehensive strategies to address eating disorders among youth. By staying informed of these trends, professionals can better advocate for resources, implement effective prevention programs, and support affected individuals and their families in navigating the path to recovery.

Guidance for School Professionals in Supporting Students with Eating Disorders

School professionals are well positioned to play a key role in early identification of youth with eating disorders and they have an ongoing role in supporting the recovery process. Consider the sheer number of hours a youth spends in the school environment compared to the amount of time spent in a medical office. If you are a school-based health professional, social worker, counselor, or other professional involved in supporting students, early identification  starts with keeping these strategies top of mind.

1. Promote a Positive School Environment

Work towards creating an inclusive and supportive school culture that celebrates diversity and promotes body positivity. Anti-bullying campaigns are a key part of these initiatives. While not exclusively focused on eating disorder prevention, anti bullying campaigns are an important component of developing a positive school climate where students feel respected. Additionally, media literacy programs and curricula will help students critically evaluate societal and media messages about body image. 

2. Implement Universal Screening and Other Early Intervention Strategies

Universal screening empowers schools to identify youth who may be struggling with underlying psychological factors, like low self-esteem, loneliness, depression, or anxiety, that increase the risk of eating disorders. They also help ‘catch’ the students who do not have full-blown eating disorders but who are engaging in disordered eating habits. Consider utilizing a health technology to implement age- and risk-targeted screening with evidence-based interventions to ensure no students go unnoticed, and there is a clear workflow to streamline the referral process. 

3. Facilitate Access to Resources

Keep an updated list of resources available to share with students and their families with information about local resources, including counseling services, support groups, and treatment programs specialized in eating disorders. ΛDΛM allows users to incorporate community-based resources into the intervention process for those youth who need more intensive care. 

4. Collaborate with Parents

Recovery from an eating disorder requires the support of a team. The team nearly always includes the parents/caregivers. As a school-based health professional, When appropriate, and with the student’s consent, involve parents or guardians in the support process. Share observations and concerns, and work together to seek professional help for the student.

5. Support Academic Accommodations

Understand that recovery from an eating disorder requires time and may impact a student’s academic performance. Youth with diagnosed eating disorders may be eligible for a 504 Plan or possibly an Individualized Education Program, depending on (if) and (how) the disorder is impacting the student’s experiences at school. Consider ways to be flexible with assignment due dates and/or provide options for how students demonstrate their knowledge. Accommodations can help reduce stress and support the youth’s journey towards recovery.

Balancing Body Positivity and Healthy Choices

When messages about body image and health are often conflicting, finding a balance between promoting body positivity and encouraging healthy choices is essential, especially for youth who are vulnerable to eating disorders. One way to do this is to focus on health, not weight. Encourage behaviors that contribute to overall well being, like eating a balanced diet and trying a new form of exercise for fun – without the emphasis on weight loss or gain. This approach helps shift the focus from appearance to health. Similarly, focusing on intuitive eating principles, which involve listening to the body’s hunger and fullness cues and eating in response to these signals rather than diet rules, will help youth (and all of us, actually) develop a healthier relationship with food.

Other tips for balancing body positivity and healthy choices: 

  • Validate feelings while gently challenging unhealthy behaviors
  • Recognize underlying mental health needs  
  • Model positive self-talk and behavior
  • Advocate for policy change
  • Honor the individuality of each youth to support self-esteem and build resilience 

By balancing the promotion of body positivity with the encouragement of healthy, intuitive choices, professionals can support youth in developing a positive self-image and a healthy lifestyle. 

Navigating the Path to Support Youth with Eating Disorders

Eating disorders in youth represent a multifaceted challenge requiring informed, compassionate, and coordinated responses from professionals across various sectors. From identifying risk factors and implementing early screening to engaging in effective interventions and promoting a balance between body positivity and healthy choices, the role of professionals in supporting affected youth is both crucial and impactful.

Possibilities For Change is proud to be a leader in identifying and reducing youth risk. With the development of ΛDΛM, our comprehensive technology, alongside other evidence-based screening tools and professional development opportunities, teams are equipped to effectively identify and intervene at scale, guiding more at-risk youth toward healthier, safer lives. 

Schedule a call today to discover how ΛDΛM can support your professionals in identifying and intervening with youth at risk for eating disorders. Whether you care for youth in a college, school, health department, medical office, mental health clinic, or another setting, ΛDΛM can work for you.