How to Help Your Teen Recover from an Eating Disorder: A Parent's Guide

Written by Cristina Luibil, MS, RD, LDN with support from Sabrina Stadelman.

How to Help Your Teen Recover from an Eating Disorder: A Parent's Guide

If your teen has recently been diagnosed with an eating disorder, you may be feeling upset, confused, worried, scared, or unsure of how to help. These feelings, and any other emotions you or your family may be experiencing, are normal. Eating disorders are serious and complicated mental health conditions. While there’s no quick fix, your teen can recover with time, patience, and support.

Eating disorders harm both mental and physical health. There are many different types of eating disorders. They all involve restriction of food intake, behaviors such as excessive exercise or purging after eating, and/or disordered eating actions and thoughts. For growing teens, restriction of food intake can lead to delayed puberty, slowed growth, low bone density, and negative impacts on brain development and concentration. If your teen has an eating disorder, your support is an essential part of their recovery.

Parents and caregivers support their teen by taking an active role in their recovery. By looking for help and reading this blog, you have already stepped into this role. Throughout recovery, your teen will need support during mealtimes. It is important to understand your teen’s nutritional needs during recovery. With the help of a registered dietitian, you will need to provide food and snacks needed for renourishment and nutrition rehabilitation. Your teen will also need emotional support. Recovery isn't only about eating enough. It's also about addressing and reducing eating disorder behaviors. As parents and caregivers, you can create an environment that supports recovery and helps your teen thrive. 

What Does Recovery Actually Look Like?

Eating disorder recovery involves addressing nutritional needs, reducing eating disorder behaviors, and understanding the psychology behind the behaviors. Eating disorder treatment requires a multidisciplinary team. The main goals are to increase food and nutrient intake, address restrictive behaviors, and work through the thoughts and feelings that lead teens to restrictive behaviors. 

In eating disorder recovery, teens and their families will work with a dietitian to address nutritional needs. Dietitians will work with the teen and their families to increase nutrient and calorie intake. Weight trends, growth, and laboratory testing will need monitoring by a dietitian and physician to make sure that calorie and nutrient intake is improving. Oftentimes, a psychiatrist is involved if the teen needs specialized medication management for the eating disorder and co-occurring mental health illnesses. Working with a mental health therapist is also necessary. Therapy helps teens to challenge the thoughts, feelings, and beliefs that lead to restrictive behaviors. Therapy also helps teens to develop healthy coping skills. 

What is Nutrition Therapy and How Does it Help with Eating Disorder Recovery? 

Nutrition therapy is at the intersection of medical nutrition therapy (the clinical side of dietetics) and nutrition counseling (the behavior change side of dietetics). Nutrition therapy is extremely important in eating disorder care. It provides compassionate care not only for nutrition, but also overall health, well-being, and access to necessary resources. Nutrition therapy supports a patient’s individual needs related to food, eating, and body image. 

Dietitians at Aterra Nutrition provide nutrition therapy. We work with our patients through a non-diet perspective to discover eating patterns that work for their individual recovery goals, routines, and seasons of life. Our dietitians monitor this along with the overarching eating disorder recovery needs.

What Can Parents Expect During Eating Disorder Recovery?

It’s important to remember that recovery takes time. It may be a very slow process and will likely be very difficult at first. Your teen will need a lot of support and monitoring at the beginning. Parents and caregivers will need to take full responsibility for preparing food. They will also need to make sure their teen is eating all their meals and snacks.

 At first, parents and caregivers will have to take control of meals and snacks and what their teen is eating. This is the first of the three phases of Family Based Therapy (see the 3 Phases of FBT below). This can be challenging for both parents and teens, but it won’t be forever. As teens recover, they will gradually be able to have more autonomy over their food choices again. 

No matter what stage of recovery they are in, the most important thing that you can do is meet your teen where they’re at. Recovery is difficult, but remember that your teen needs you. By taking an active role in their recovery, you are providing them with the support that they need. 

What Role Do Parents Play in Their Teen’s Eating Disorder Recovery?

Parents and caregivers provide emotional encouragement and create a supportive home environment. They prepare and serve meals, encourage open communication, and make mealtimes positive. Parents and caregivers will work with dietitians, physicians, and therapists. Parents and caregivers will be an important part of their teen's treatment team.

For a teen with an eating disorder, a supportive environment is extremely important. Eating disorders can be very isolating. Recovering teens need consistent support throughout their recovery. Even once a teen has recovered from their eating disorder, families can still help to support long-term recovery and well-being. One way to do this is to ensure the home is free from diets/diet culture, triggering language, and negative food and body comments and opinions. These types of comments can cause a teen in recovery to spiral. 

Parents and caregivers provide this support in many important ways. This includes preparing food and ensuring their teen is eating enough for recovery. Parents and caregivers also play an important role in making mealtimes positive. The home should be a safe space where teens don’t feel pressured to eat or shamed for what or how much they’re eating. Parent and caregiver involvement is important for the success of treatment.

When Should a Teen See a Registered Dietitian?

When a teen is struggling with an eating disorder, they should see a registered dietitian as soon as possible. It is best to meet with a dietitian once a week for at least the first 3-6 months of recovery. This allows a dietitian to gain an understanding of your teen’s and your family's unique needs. 

Dietitians have in-depth knowledge of nutrition and what meals and snacks should look like for each individual client. Recovery meal plans should be overseen by a dietitian to make sure that recovering teens are getting what they need. Dietitians can also help the families to navigate eating disorder recovery and the necessary changes to meals, snacks, and routines. Many families and clients work with a registered dietitian for many months or even years. The amount of time you and your teen work with a registered dietitian will depend on the severity of your teen’s eating disorder, progression of recovery, and recovery goals. 

If you see signs that make you think your teen might have an eating disorder, it is a good idea to see a registered dietitian. Eating disorder-informed dietitians are trained to recognize the signs of an eating disorder, and will refer appropriately to a doctor or therapist to make a diagnosis when needed. Even if your teen hasn't been diagnosed, a dietitian can help them learn how to have a healthy relationship with food and their body. If your teen is showing signs of any disordered eating behaviors, they should see a dietitian.

Signs of Disordered Eating / a Potential Eating Disorder 

• Skipping meals or snacks

• Cutting out foods or food groups they used to enjoy

• Making strict rules around eating

• Avoiding social events, especially when they involve food

• Spending a lot of time counting calories or planning meals

• Excessive exercise

• Cutting out calorie-dense foods or entire food groups (such as fat, carbs, etc.)

• Weighing themselves every day or many times per day

• Secretive eating or not wanting to eat in front of others

• Significant or rapid weight loss

• Irritability or intense mood swings

• Sluggishness or tiredness

• Decreased ability to concentrate

• Feeling cold, even in warm surroundings

• Dizziness or fainting

• Becoming sick after eating

• Lack of or disruption in menstrual cycles in teen girls

  
  

If you notice any of these signs or behaviors in your teen, you should see a registered dietitian who can provide your teen with the support they need. 

What is Family-Based Treatment and How Does It Support Teen Recovery?

When possible, Family-Based Treatment (FBT) is the best option for teens in eating disorder recovery. FBT is an evidence-based treatment plan that places parents and caregivers at the center of treatment. Families receive support from a treatment team. This team includes an ED specialist dietitian, therapist, psychiatrist, and physician. FBT supports teen recovery because it prevents family separation during recovery. 

FBT allows parents and caregivers to have input. It creates a more effective treatment plan by involving family members in treatment decisions. It also helps teens to be in a more familiar environment with their family during recovery.

There are 3 phases of FBT:

Phase 1: Full parental control and involvement in preparing, plating, and serving the teen food. Parents must watch their teen at meals to ensure the teen is eating all their meals and snacks. The teen’s only “job” during this phase is to eat all their meals and snacks. 

Phase 2: Gradually gives the teen a bit more autonomy in the eating process. Starting phase 2 depends on the teen’s nutritional, psychological, and medical stability. The level of input the teen gets in the eating process depends on a conversation between them, their dietitian, and parents. 

Phase 3: The teen can start plating their own meals and snacks. They will have less monitoring during meals. They will still follow a recovery meal plan and their dietitian will recommend any changes as the teen continues on through this process. 

What if My Family Cannot Commit to the Full Scope of FBT?

Whether due to work/school schedules, other necessary obligations, or because your teen wants (and is capable of) more agency in their treatment, at Aterra Nutrition we take an FBT-informed approach to the nutrition side of things. This means we meet the teen and their family where they are in terms of how “regimented” families’ roles are. If the teen has expressed wanting more agency in their treatment, we will try it out and honor that. However, we are always cognizant of the eating disorder voice speaking for the teen, and we assess each situation with care. We also meet parents where they are in terms of their capacity for involvement. In our experience, we have found that we are able to better help our families if we take into account realistic family barriers. We work with you to make FBT work for your family rather than only following the more strict or “manualized” FBT regimen.

What Shouldn’t You Say to a Teen with an Eating Disorder?

Avoid any mention of body weight or shape, dieting or restricting foods, and your own food-related health issues or concerns. Be aware of any language that puts pressure on the teen to eat or criticizes what they are or are not eating.

The language that's used to talk about food, eating habits, and body shape/size is very impactful. Comments that encourage dieting and disordered eating habits negatively affect teens. Comments about body shape or size are also harmful. They can lead teens to feel guilt or shame about their eating habits and their bodies. We should avoid labeling any food as “good” or “bad”, “healthy” or “unhealthy”. We should also avoid commenting on body weight or shape and use neutral ways to describe food and bodies. 

Parents and caregivers can support recovery by modeling a healthy relationship with food. This means avoiding commenting on the eating habits or food choices of others. This includes avoiding making negative comments about their own bodies. Parents should avoid dieting themselves or talking about diets around their teen. It also involves making mealtimes positive. In this way, you can help your teen to overcome the eating disorder and build a better relationship with food/body for themselves. Read more about what you shouldn't say to a teen with an eating disorder.

How Can I Support My Teen at Mealtimes During Eating Disorder Recovery?

Focus on using mealtime as a way to connect and enjoy time together as a family. Avoid commenting on food and body size, not only in relation to the teen, but in relation to anyone. Take the attention away from triggering topics of food or eating habits. 

During mealtimes, focus on topics like school, friends, family vacations, work, future dreams and goals. Don't comment on what or how much a teen (or anyone) is eating, and don't put pressure on them or threaten them to eat. Avoid commenting on these topics for anyone else at the table as well. 

In eating disorder recovery, it's important for your teen to eat enough to support renourishment and nutrition rehabilitation. It's important to understand that eating is not easy for recovering teens. Although teens need to meet their energy needs in recovery, pressuring or threatening them to eat isn’t helpful. Teens with eating disorders already experience extreme stress and anxiety at meals. The goal is also to help meals and eating feel enjoyable again. Taking the attention away from food and/or body is key to making mealtimes a less stressful experience for your teen. 

Why Does Your Support as a Parent Matter?

Parents and caregivers play an important role in supporting their teens in recovery. Parents and caregivers are often the first to recognize changes in behavior and other signs of an eating disorder. If you suspect your teen may have an eating disorder, it’s important to get help as soon as possible. 

Eating disorders are serious and complex. Getting your teen the help that they need is vital, and your support throughout their recovery is essential to help them heal. As their parent or caregiver, you play a huge role in their recovery. The most important thing is letting them know you’ll be there for them every step of the way. 

If you’re looking for support for a teen struggling with an eating disorder, Aterra Nutrition offers virtual nutrition counseling and support for eating disorder recovery with a registered dietitian. We offer one-on-one nutrition counseling for those in DC, Maryland, Virginia, West Virginia, New Jersey, and Michigan. Learn more about the eating disorder services Aterra Nutrition offers on our website at aterranutrition.com.

About the Author

Cristina Luibil, MS, RD, LDN specializes in eating disorder recovery and Intuitive Eating for teens and adults. Aterra Nutrition provides virtual nutrition counseling for those in DC, Maryland, Virginia, West Virginia, New Jersey, and Michigan. This post was researched and written in conjunction with Sabrina Stadelman, dietetics student and nutrition assistant at Aterra Nutrition. Learn more about the whole team at aterranutrition.com/about.

Disclaimer: The information shared in this blog is for general educational and informational purposes only. It may not be tailored to your specific health needs as it is written here. This content is not intended to replace personalized medical advice, nutrition counseling, or medical nutrition therapy. Any recipes or suggestions provided are meant to inspire and should be used at your discretion. Always consult with your own registered dietitian, physician, or healthcare provider before making changes to your nutrition, lifestyle, or treatment plan. If you choose,

Aterra Nutrition would be happy to help you in your individual nutrition and Intuitive Eating goals.