How to Distinguish Between Normal Teenage Behavior and an Eating Disorder
“In a large study of 14- and 15-year-olds, dieting was the most important predictor of a developing eating disorder. Those who dieted moderately were 5x more likely to develop an eating disorder, and those who practiced extreme restriction were 18x more likely to develop an eating disorder than those who did not diet.” - Neville H. Golen et. al.
What is Normal Teenage Eating?
It is no surprise that teenage eating habits can look different from adult eating habits. Teenagers are managing increased nutrition needs and growth alongside many factors that can influence food choices. Some of these factors include:
Growing independence
Peer relationships
Busy school schedule
Sports and/or extracurriculars
Development of personal self-image
Development of personal morals and values
Family culture
With all of these changes happening, it is challenging for parents to know what behavior is normal and what is something that merits raising concern. Often this involves an understanding and awareness of different teen eating disorders and how they can develop, as well as an awareness of what normal eating can look like for teens as they navigate their personal and individual autonomy.
Common teenage eating behaviors include:
Skipping meals
Fast food consumption
Frequent snacking
Dieting
Vegetarian or vegan diets
What is an Eating Disorder?
As mentioned above, it is helpful to know what different eating disorders are and how they present in order to be able to help distinguish when a behavior is concerning. This is especially important as often eating disorders begin to develop during adolescence and teenage years. Overall, eating disorders are a serious but treatable mental and physical illness. Below I will summarize what each of these disorders are and how they are diagnosed. Note that these are not comprehensive descriptions of each eating disorder.
Anorexia Nervosa: restriction of food relative to the individual’s body’s needs
Commonly includes: fear of weight gain, body dysmorphia, persistent behavior preventing weight gain, excessive exercise, extreme dieting, fasting
Bulimia Nervosa: eating a large amount of food in a short period of time followed by purging.
Commonly includes: fear of weight gain, persistent compensatory behavior to prevent weight gain, vomiting, misuse of laxatives, diuretics, fasting, body dysmorphia, excessive exercise
Binge Eating Disorder: eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment.
Commonly includes: the absence of compensatory behaviors an mentioned above, feelings of intense guilt and/or shame, sometimes feelings of depression
Avoidant Restrictive Food Intake Disorder (ARFID): avoidance of food based on sensory concerns (ex: texture, smell), concerns about adverse consequences of eating (ex: choking), or ongoing intense worry, anxiety, sadness, or general obsessive thoughts that interfere with eating.
Commonly includes: absence of weight or body size concerns, failure to meet appropriate nutrition and energy needs such that significant weight loss occurs and there is interference with psychological functioning
Other Specified Feeding or Eating Disorder: feeding or eating behaviors that cause clinically significant distress and impairment but don’t meet the full criteria for other eating disorders.
While your teen may not be displaying all of the specific criteria of one of these disorders, it is important to be aware of what signs and symptoms are common to each type of eating disorder.
How do Teens Develop Eating Disorders?
There are multiple risk factors for developing eating disorders and disordered eating ranging from environmental to genetic. Here are some examples:
Family history of eating disorders
Family members dieting
Genetics
Anxiety
Life changes/transitions
Trauma
Dieting
Sports
Low self esteem
Body dissatisfaction
The development of an eating disorder is complex and typically involves multiple risk factors.
How Common are Eating Disorders in Teens?
Statistics from the Eating Disorder Hope website and NEDA feeding hope show that:
2.7% of teens will experience an eating disorder in their lifetime
13% of adolescents will develop an eating disorder by age 20
1.6% of teens will engage in binge eating disorder symptoms and behaviors
Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors
15% of transgender youths had elevated scores on the eating disorder examination questionnaire
5 common teenage eating habits, how to know if it’s disordered eating, and when to have concern as a parent:
Behavior #1: skipping meals
This is a common behavior in eating disorders but also a common behavior to see in teens (and even some adults!). As with most of these behaviors, it is important to get an idea of the thought process and motivation behind the behavior. A few common instances that may lead to meal skipping are:
Busy schedule
Forgot to eat
Overslept
Not hungry
Over-snacking
Illness
Forgot to plan a meal
While it is never encouraged for anybody to be missing a meal, it can happen from time to time and is not always a cause for concern. Teenagers have been shown to have more impulsive tendencies that can lead to unintended meal skipping because of poor planning.
This behavior can also be a red flag for eating disorder development. If you notice your teen frequently skipping meals and/or sharing that they are not hungry when you know they have not eaten for a few hours, this should raise concern.
Teenagers are developing and growing at a rapid pace and because of this they especially require regular and balanced nutrition to support their development. If your teen is skipping meals in an effort to lose weight and restrict calories it is important to notice and explore this behavior and motivation further.
Behavior #2: fast food consumption
It is common and normal for teenagers to be eating out more often when the opportunity arises. This is related to teens being at a developmental stage that makes them naturally more impulsive as well as wanting to be with their peers more often. Reasons a teen might choose fast food more often:
Convenient
Efficient
Social opportunity
Tastes good
Hunger after school
Hunger after extracurriculars
Forgot to plan a meal
Novel food experience
Fast food is a quick decision that is readily available and easier to choose than planning out a meal in advance. For the most part, eating out is not a behavior to be concerned about. This behavior becomes concerning if your teen is eating out in secret. This can be related to your teen being overly restrictive and feeling uncontrollable hunger. Your teen could be feeling shameful about the stigma that comes with eating fast food and not wanting people, or you as a parent, to know they are eating it. It could also be a sign or symptom of binge eating disorder if your teen is wanting to go out and eat foods in secret away from the home.
Behavior #3: frequent snacking
If you're a parent of a teen you know that frequent snacking is a common behavior. Research, as well as anecdotes, have shown us that it is especially common to see teens snacking. Common times to notice this are:
after school
while watching TV
while with friends
to or from school
Late at night
Snacking can be a result of:
Boredom
long periods of time between meals
a social behavior
a missed meal earlier in the day
general increased hunger and nutrition needs
For the most part, snacking is not something to be concerned about and something that is a part of a normal eating pattern. The time to start asking more questions is if frequent snacking starts to replace mealtimes and results in undernourishment. This is especially true if your teen is choosing small snacks over meals with the intention of weight loss as a form of calorie restriction.
Behavior #4: Dieting
Dieting is a common behavior to see in teens and can develop for multiple reasons. Teens are developing a sense of body image and self awareness as well as starting to feel a strong influence from peers. Noticing their own bodies for the first time and also noticing their peers’ bodies can lead to comparison and negative self-talk.Common reasons a teenager may start a diet:
Their friends are doing it
It is a new idea they learned
They are trying out different ways of eating
They want to lose weight
They want to change their body
Their family is doing it
They want to be “healthy”
Dieting is dangerous behavior for teens to be engaging in and can often lead to undernourishment as well as an eating disorder. Always explore why your teen may be interested in starting a diet and what they are hoping to get from a diet.
Behavior #5: Vegetarian or vegan diet
It is not uncommon for a teenager to try out a vegetarian or vegan diet. Teenagers are in a stage where they are developing their own personal identity, morals, and ethical value system. Vegetarian and vegan diets are often a result of one’s personal conviction to reduce animal based products in their diet in order to protect against animal cruelty. This is a valid lifestyle and can be a balanced diet for any person, including teens.
When these diets become problematic is when they are used as a form of restriction under the guise of protecting animals and/or “health”. These diets come with a stereotype that they are healthy and ethical which removes suspicion from peers and adults around who might question the teen’s restriction otherwise. These stereotypes make the restrictive nature of the diet appear ethically based rather than diet culture based. If your teen is trying a vegetarian or vegan diet purely to control their body size and weight it is worth considering further discussion on the choice.
Bottom Line
If you start to notice any concerning eating behaviors in your teen, approach questions from a place of curiosity. It is possible that your teen is not aware of the dangers of calorie restriction and dieting, or is being misled by another influence. It is also important to take concerning behavior seriously. Eating disorders and disordered eating are serious and should be addressed as soon as possible.