Coaching Caregivers to Respond to Eating Disorders and Body Image Concerns

Eating disorders originating from body image concerns are one of the most frightening and dangerous mental health challenges to navigate for providers, parents, and patients alike, especially given the higher rates of self-harm and suicidal ideation in this population. This issue is becoming increasingly prevalent, doubling in the general population since 2000, with nearly one-in-four children and adolescents displaying disordered eating.

As part of the Coaching Caregivers Lunch & Learn series at Proven Practice, I’ll be hosting a talk on December 5th at 12 PM EST to share practical strategies for providers who are working with caregivers of teens struggling with eating disorders or body image issues. Below are some of the key strategies that I will explore during this session.

Prioritizing Goals and Targets

When treating teens with eating disorders, the first step is to evaluate the teen to see if they meet criteria for a diagnosis, while also assessing the severity of the symptoms and their impact on the teen’s physical and emotional well-being. Eating concerns often overlap with other behaviors like self-harm, emotion dysregulation, or risky behaviors. Prior to taking any action, it is always critical to address any immediate safety issues first.

Key Steps for Caregivers

1. Assess Growth and Consult a Pediatrician
   The first step when addressing eating concerns is evaluating the teen’s growth and consulting their pediatrician. From here, there are two potential paths: If the teen’s pediatrician is not concerned about growth, your objective is focusing on prevention, which I will detail throughout this post. If there are concerns about weight or other physical health indicators, then adolescent medicine and psychiatry specialists must be involved. During our April Lunch & Learn, we’ll dive deeper into the second track, which involves collaboration with a multidisciplinary team.

2. Implement Family Meals
   Family meals play a vital role in addressing eating behaviors. Coach caregivers to sit down for three family meals a day, creating a sense of normalcy and connection via the routine. Teens are required to attend meals but retain autonomy for what and how much they eat. During meals, instruct caregivers to keep conversations positive, light, and unrelated to food, focusing instead on more neutral topics like school, friends, or activities. 

3. Address Food Rituals and Diet Requests
   Many teens with eating concerns may exhibit OCD-like rituals around food and/or have specific diet requests. These behaviors should be handled gently and in as neutral a manner as possible, to minimize mealtime friction. For example, cleanliness rituals should be ignored or complied with casually and without urgency. This approach helps reduce the focus on controlling behaviors, while fostering a calm and enjoyable mealtime environment.

4. Stock Nutrient-Rich Foods
   An often overlooked, but critical treatment step is ensuring that the home is stocked with full-fat, nutrient-rich foods. Caregivers should avoid buying anything labeled “sugar-free” or “fat-free,” and use full-fat dairy products. Additionally, adding extra butter or oil to meals increases their calorie density, which can support growth in teens who may need to gain weight. While these suggestions may seem obvious, they are frequently overlooked by caregivers, so reinforcing this treatment step is crucial.

5. Examine Parental Beliefs and Behaviors
   Parents’ attitudes toward food and body image significantly influence their teens. Encourage parents to model positive behaviors by enjoying meals without guilt or judgment, and avoiding commentary that creates a negative association with food (e.g., “I need to walk off that dinner” or “No bread for me, I’m cutting back on carbs”). Creating fun, food-focused experiences, like going out for ice cream or sharing a treat together, helps normalize food as part of life and builds positive associations.

6. Responding to Negative Self-Talk 

   When teens express thoughts like, “I’m fat” or “I’m ugly,” caregivers should resist the urge to argue or correct them. Instead, they should validate their feelings by acknowledging them with phrases like, “We all feel that way sometimes.” Caregivers can model positive self-talk by sharing what they do when they feel dissatisfied with their body and highlighting their own favorite qualities about their bodies. This approach can open a dialogue to help teens identify attributes they like about themselves. Finally, engaging in a coping skill together—such as watching a show, going for a walk, or enjoying a treat—can shift the focus toward connection and self-care, helping to proactively address any deeper, underlying issues that may surface as disordered eating.

Join Us on December 5th

Click here to register for this Lunch & Learn where we will take a deeper dive into the steps summarized above, providing practical tools for addressing eating disorders in teens. 

Looking Ahead: The April session will build on this discussion, focusing on advanced strategies for more severe symptoms and building a multi-disciplinary team.

Disclaimer:

The information provided in this blog post and during Lunch & Learn sessions is for educational and informational purposes only and does not constitute medical, psychological, or professional advice. It is not a substitute for individualized consultation, diagnosis, or treatment by a qualified professional. If you or someone you know requires specific support or treatment, please consult a licensed healthcare provider. Participation in these sessions or reliance on the content provided does not establish a professional relationship or supervision. Proven Practice and its affiliates are not liable for any outcomes resulting from the application of this information.