My Daughter Is Getting Too Skinny

A distraught mother sent me this question:

"I am the mother of three girls. Their ages are 18, 15, and 11. The younger daughters have always had healthy eating habits and have been easy kids. My 18-year-old daughter has a more challenging personality. She is an anxious perfectionist and will be attending a prestigious college in the fall. Additionally, she has always been a picky eater, even though she does not have food allergies. Recently, she has started to eliminate specific foods from her diet. First, she started eliminating meat and fish from her diet. She said that the idea of eating animals feels wrong to her. Then she cut down on carbs. More recently, she has eliminated even more food from her diet. In addition, she has been running almost every day and won't allow herself days off from exercise.

I do not know how much weight my daughter has lost, but it is clear to me that she looks too skinny. She looked beautiful before she lost weight. When I asked her about why she is losing weight, she said that her arms were too big compared to the rest of her body. I don't know where she got that idea. Her arms have always looked fine to me. I am going to take my daughter to the pediatrician to get her advice. In the meantime, my husband and I are confused about how to deal with my daughter's eating and exercise habits. We are wondering how much to intervene and whether or not to address her eating habits directly. We don't want to make any dreadful mistakes. We have been buying what she calls her safe foods. This includes fruit, vegetables, and almonds. Sometimes, she won't eat what I prepare for dinner and instead prepares her own low-calorie dinner. This all feels like a slippery slope, and we don't want our daughter to get any skinnier and/or develop health issues."

Please help.

And my response:

I am so pleased that you reached out to me. Your daughter is likely dealing with anorexia nervosa, which involves dietary restraint, lots of exercise, and body image issues. You describe your daughter as an anxious perfectionist. This is the personality type of those who develop eating disorders. These young women feel that they must be perfect at dieting, and their self-worth becomes associated with controlling their weight and caloric intake. It is possible that one of the factors that led to the onset of this eating disorder was the college admission process. This is an extremely difficult time. I am sure that your daughter is relieved that she got into a prestigious school. Keep in mind, though, that going to college is a major transition, and your daughter may be anxious about the change.

I suggest that you take your daughter to the pediatrician to check on her health as soon as possible. You should also find an excellent therapist and nutritionist who both have experience working with teens with eating issues. My advice to you is that you should encourage your daughter to eat dinner with the family. Exercise should be contingent on eating whatever you prepare for the whole family. You need to help your daughter, and by making exercise contingent on eating with the family, you are helping her. Anorexia nervosa is a family problem and should be treated as such. Your daughter's therapist and nutritionist will also guide you. Get to these appointments as soon as possible. The earlier you treat anorexia, the less likely it is to become more severe. The prognosis is better when it is treated early.