When to Worry: Early Signs of Eating Disorders in Adolescents

By: Rebecca Kinshella, LPC, PHM-C, Eating Disorder Specialist at Dr. Vaccaro Counseling Group

Adolescence is one of the most common periods for the onset of an eating disorder. Body changes, emotional variability, societal pressures, and constant exposure to bad recommendations about food and weight are literally at their fingertips, daily. 

As parents, it is important to not only understand potential signs and symptoms of eating disorders, but recognize and act if something in your child begins to shift. 

I like to tell parents: your instinct is usually ahead of your intellect. Pay attention to it. 

Eating disorders are a serious and complex set of illnesses that require specialized support, and early intervention is a key factor in achieving a full and lasting recovery. Whether you are concerned about your child’s eating, or perhaps just wanting to be informed and proactive in keeping an eye out for signs and symptoms, recognizing early warning signs can make a meaningful difference.

Weight loss or inadequate weight gain: 

During puberty, most children should be gaining weight as their bodies grow and develop. Just like at younger years, you should see their weight increase at their check-ups. However, in a society that over-values thinness to the detriment of these kids, weight gain after young childhood can often be feared and vilified. Weight loss can be overlooked, or even unintentionally reinforced. When weight loss occurs, or when expected weight gain plateaus, it is important to pause and assess what may be contributing to that shift and discuss this with your child’s pediatrician. 

Dietary restriction of any sort: 

“Dieting” to try to manipulate body size is unfortunately still alive and well. Research shows more than 60% of teenage girls and 25% of teenage boys have reported trying to lose weight, highlighting just how normalized these behaviors have become (1) If your child has suddenly expressed an interest in “healthy” or “clean” eating, is engaging in a restrictive diet such as going gluten- or dairy-free, or is actively “dieting” in an attempt to lose weight, pay attention. These changes may seem good to some – aren’t they just trying to be healthier? However, a significant change in diet and relationship with food can be an important sign that an eating disorder is developing, and should not be ignored. 

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Restriction of food itself can actually trigger the onset of an eating disorder. Therefore, for some adolescents, what starts as an interest in “eating better” can quickly evolve into rigidity, fear, and control around food.

If there is a biological predisposition for an eating disorder, these new eating behaviors can be the match that lights the disorder ablaze.

This is where many families get caught off guard, because what looks “healthy” on the outside may not feel flexible, nourished, or sustainable on the inside.

Changes in exercise patterns: 

Healthy exercise/movement is typically fun, varied, and flexible. When exercise becomes rigid or tied to guilt, it may indicate something deeper. Over-exercise is a common form of compensatory behavior in an eating disorder. 

Ask yourself:

• Does exercise seem tied to “making up for” food?
• Are there strict rules about when or how long they must exercise?
• Do they continue even when sick, injured, or exhausted?

When movement shifts from something that supports well-being to something that feels compulsory or punishing, these may indicate an unhealthy relationship with exercise that needs to be addressed.

Dental issues: 

It may surprise you to learn that the first person to become aware of a teen’s eating disorder just might be their dentist! Some teens attempt to “purge” food through compensatory behaviors such as vomiting or using laxatives. If intentional vomiting becomes habitual, such as in bulimia nervosa or other related conditions, stomach acid can begin to erode teeth and cause dental cavities and other issues. If you have suspicions of these behaviors in your child, collaboration with your child’s dentist can be an important step. 

Significant body distress: 

Adolescence is hard – so many things change in a short period of time, including bodies. Unfortunately, this can cause a lot of body image distress and discomfort. 

Some amount of discomfort is normal as they get used to all of the changes. However, if you are noticing significant body image distress, it is important to probe further for a potential eating disorder. 

Signs of Body Distress may include: 

1. Avoidance of showing their body, such as wearing loose/baggy/long clothing, refusing to wear a swimsuit, or avoiding being photographed. 
2. Regular comments about theirs or others’ appearance (positive or negative). This indicates a preoccupation with how they look in a likely unhealthy way.
3. Frequent “checking” behaviors, such as checking their reflection in the mirror or feeling for a “flat stomach” or other desired attribute. 

These patterns often reflect more than insecurity, they point to a growing preoccupation with body image that can become central to how a teen experiences themselves.

*If You’re Concerned, Trust That Instinct*

Part of the challenge with eating disorders is that adolescents are often unaware of the severity of what they are experiencing and/or will lie to avoid being “found out.” Additionally, the signs outlined here are not exhaustive, and no single behavior confirms a diagnosis. 

If you’re noticing patterns and wondering whether something more is going on, you don’t have to figure that out alone.

It is important to seek the advice of trained professionals who can help assess if an eating disorder is present, and how severe it might be. Your child’s pediatrician can be a good place to start. From there, an eating disorder specialized therapist and/or dietitian will be able to provide clarity and guide you in the appropriate next steps of the process. You can also review a more comprehensive list of warning signs through the National Eating Disorders Association. 

Early intervention is key, and you do not need to wait until you are certain to seek support. Parents are often the first to notice when something feels “off,” even if it’s hard to name. In my experience, I see over and over again that parents are not just observers in this process, they are one of the most powerful protective factors and assets in a child’s recovery.

My role is not only to support the adolescent, but to equip parents with the understanding and tools needed to navigate this with confidence.

If you believe you could use some support in addressing concerns about your child’s eating or body image, please feel free to reach out. I would be happy to come alongside you in this journey as you seek full wellness for your child. Taking that first step early can make all the difference.

Contact me, Rebecca Kinshella, LPC at Dr. Vaccaro Counseling Group (469) 887-1633 to get started.