Supporting Youth With Eating Disorders

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Co-authored by Vicky Wang, B.S., and Eunice Yuen, M.D., Ph.D.

The end of the year can be stressful. It starts with decorating, shopping, traveling, and finally, celebrating with loved ones—often with a feast. Food can be comforting. A pre-pandemic caloric intake estimate of the average American on Christmas day was a staggering 6,500 calories, three times the daily recommended amount according to the U.S. Food and Drug Administration (FDA) guidelines.

In this post-pandemic era, food can also be the culprit. Since the onset of the COVID-19 pandemic, there has been a dramatic increase in the number of youths grappling with eating disorders, with cases among teens doubling in the pandemic's initial year. Amplified with familial bonds and the pervasive influence of cultural expectations and social media, the celebrations are overwhelming for those grappling with food-related challenges.

While casting a glow of joy on family gatherings and elaborate meals, let us be aware of this silent epidemic and support young lives who are affected.

Eating disorders are complex medical and mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classification includes anorexia nervosa, bulimia nervosa, binge eating, avoidant restrictive food intake (ARFID), and others. Research indicates a lifetime prevalence affecting 10 percent or 29 million Americans.

While these disorders can emerge at any age, as young as 5 years old to those as old as 80, adolescence is often the starting point. A new study suggests that 1 in 5 teens may grapple with disordered eating behaviors. The longevity of these struggles can last an average of eight-plus years.

Moreover, a comprehensive review delves into the profound impact of eating disorders on mental and physical health, a litany of psychiatric and medical comorbidities, including depression, anxiety, addiction, cardiovascular complications, metabolic syndrome, nutrition deficiencies, and more.

Cultural factors can have devastating effects on youth struggling with eating disorders. The holiday season, when Asian American families come together, brings heightened pressure to conform to societal appearance expectations. At the dinner table, harmful food dialogue can be presented bluntly, albeit with good intentions.

A scene from the Oscar Winning Best Picture Everything Everywhere All at Once exemplifies this. The mom, Evelyn, played by Michelle Yeoh, attempts to communicate with her daughter, Joy. However, instead of expressing her concern, she hesitates and blurts out, "You have to try and eat healthier. You are getting fat."

In response, Joy stares back with teary eyes and slams her car door.

Commonly, many have assumptions regarding how Asian Americans are well-adjusted ("model minority" stereotype). However, research found that Asian American women are not immune to a mainstream cultural emphasis on thinness and show high rates of disordered eating. Sociocultural factors, including the perception of thinness as success and environments fostering fat-shaming, impact girls and women globally.

Beyond that, there are additional risk factors that contribute to why Asian American women are more vulnerable to eating disorders, such as biculturalism and acculturative stress.

It is well known that the surge of social media has heightened struggles across age groups, especially in teens. A study on grade 7 and grade 8 adolescents reveals a strong correlation between social media use and disordered eating behaviors. A global review underlines the adverse effects of social media on body image, mental health, social comparison, and self-objectification across 17 countries.

So, how can we support those who are struggling this holiday season?

1. Recognize signs and symptoms: Some warning signs include eating alone or in secret, reduced portion sizes, withdrawal from food-related events, immediate bathroom use after eating, hyperfocus on "healthy" foods, increased exercise, and distress when "safe" foods are unavailable. Professional assessments can serve as valuable tools. An affirmative response to two or more questions necessitates further exploration and a comprehensive assessment. Recognizing risk factors is crucial in identifying potential challenges; these factors encompass a history of trauma and abuse, weight-related teasing or bullying, perfectionism, societal pressures, and more. If concerning behaviors are apparent, scheduling a visit with a pediatrician is advisable.
2. Non-judgmental and compassionate communication: Let us acknowledge that holidays can be difficult. Conversations about disordered eating with teenagers can be challenging due to feelings of secrecy and shame. A non-judgmental and curious approach with the teen in a calm state can be helpful. It is also important to remind guests of harmful food language. Well-intended comments may be culturally acceptable but not helpful.
3. Coping skills: Food can be overwhelming for struggling youths. Teens and parents can work together to identify some coping strategies before the holidays. For example, parents could encourage them to try new foods while remaining mindful not to create pressure or implicit expectations. It can also be helpful to reduce time spent on social media and engage in more family activities.

Eating Disorders Essential Reads

How Disordered Eating Becomes a Concern in the Neurodivergent

Are Eating Disorders Regulated by Our Endocannabinoid System?

This holiday season, let us strive to be inclusive, understanding, and compassionate for our loved ones. Let us acknowledge the silent battles fought by many young lives and work towards creating an empowering environment that prioritizes their mental well-being over sociocultural expectations and harmful stereotypes.

It has been the passion of CHATogether to foster open and compassionate dialogues within families and communities. We can create a space that embraces and supports the diverse journeys of individuals facing the challenges of eating disorders.

Vicky Wang, B.S., is a fourth-year medical student at Vanderbilt University School of Medicine. She serves as the Co-President of APAMSA (Asian Pacific American Medical Student Association).