Six Tips to Help Parents Raise Kids With A Positive Body Image

It’s no mystery that we live in a culture driven by appearance. Even if we know something is bad for us, if it will help us look good we can’t seem to turn it down. As the drive for visual perfection continues, young men and women are constantly told that they are not good enough. The battle begins in childhood, with elementary school children reporting that they feel fat or wish they looked a different way.

Body Image Concept

The National Association for Anorexia Nervosa and Associated Disorders recently reported “a dramatic increase in hospitalizations for eating disorders in children 12 and under.” Sadly “between 1999 and 2006, hospitalizations rose 119 percent.” This didn’t happen overnight and it won’t be solved overnight. Still, there are things parents can do to encourage children from a young age to young adulthood to value themselves and to find that value in places other than their appearance.

Focus on Character Not Curves Be intentional about complimenting character. Take the focus off the body and put it on the brain. Encourage and celebrate academic success. Spend time serving others instead of focusing on self. Invest in your children’s character development more than their physical development and they will naturally learn what is more important.

Make Food Friendly Do not use food as a reward, punishment or incentive. This is a tough one, but if you can put it into practice, you just might save yourself and your child a lot of hurt. Attaching food to success or failure adds emotions that can lead to disordered eating. Try to avoid taking away food as a punishment or implementing consequences for not “clearing the plate” at dinner.

Lose the Scale One of the best things you can do for your teen, and probably for yourself, is to get rid of your scale. Unless you have orders from a doctor to track your weight, it probably isn’t necessary to weigh yourself on a regular basis. If you do choose to keep one around, put it away when not in use. Avoid weighing yourself in front of your kids or letting them weigh themselves.

Strive for Health Not a Number In the same tone of ditching the scale; we really encourage you to strive for a healthy lifestyle. Make an effort to maintain a healthy and balanced diet. As your schedule and budget allows, make meals from scratch using whole foods. Keep healthy snack options in the home and avoid processed foods. Be active, not just through exercise, but also through spending time in activities with the whole family.

Love Yourself You are your child’s first teacher and you have a lot of power in shaping their body image and self-esteem. Choose to make yourself an example of a healthy lifestyle and positive body image. Silence the “fat talk” and be vocal about things you like about your body. Put the focus on talent and strength. Also be mindful of how you speak about other people’s appearance. In employing this tip, you just might find you are feeling better about yourself too.

Put Your Guard Up Mainstream media, youth programming included, is full of body shaming. One study reviewed 134 episodes of popular Disney and Nickelodeon shows and determined that an alarming 87 percent of the female characters ages 10-17 were underweight. Take steps to guard your children from negative body image in the media. Ditch the beauty magazines. Skip the weight loss commercials and don’t choose programs that show weight loss as a path to happiness or portray being underweight as normal or healthy.

Even if it doesn’t develop into a diagnosed eating disorder, a negative body image can impact development. Research from Common Sense Media and others shows that body image is linked to several factors of both social and emotional well-being. So as difficult as it may be, take time to talk to your teens about the issue. And take a stand, unpopular or not, to protect them from influences that impact their body image in a negative way.

 

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Is It a Diet or Is It an Eating Disorder? What Parents Need to Know

Eating disorders are a complex illness resulting from a variety of emotional and environmental factors and manifest in a variety of different ways. Often, they can go undetected, especially when unhealthy eating habits can look like a fad diet. Parents of teens may have a hard time recognizing when abnormal eating habits are leading to the detriment of their child’s health. Following are some tips that can help you spot the difference between symptoms of eating healthily while dieting and symptoms of an eating disorder.

Woman handcuffed by a tape measure

photo: bigstock

Your child on a diet:

  • Has a clear weight goal. Ask your child what their weight goal is and determine if it seems like a reasonable, healthy weight for their body.
  • Doesn’t completely cut out any food group. It’s normal to limit unhealthy or fatty foods, but part of eating healthily is eating a variety of nutrients and foods. If your child won’t touch a certain food at all, like bread or proteins, there may be a problem.
  • Limits portions, especially of unhealthy or fatty foods, but still enjoys eating. Most individuals on diets feel guilty after eating too much or too unhealthy, but not afraid. If your child seems afraid or anxious around food, especially eating in public, it may be a sign of a bigger problem.
  • Exercises because it helps them achieve their goals and feels good, not excessively or to punish themselves.

Your child with an eating disorder:

  • Doesn’t have a clear weight goal. Whatever the scale says, it won’t be low enough. They will always want to lose more and more weight.
  • Eats only certain types of foods. They seem disgusted or afraid of foods they used to like, which may be high in fat or sugar. They may also have strange eating rituals, such as cutting food into tiny pieces or rearranging it on the plate. They may also combine strange foods together, which they binge on in secret.
  • Limits portions to extreme degree of low calorie intake and skips meals. Individuals with eating disorders will often make excuses not to eat. Either they are not hungry, just ate with a friend, or are not feeling well.
  • Has an unhealthy body image. They complain about being fat regardless of how thin they are or how much weight they’ve lost. They seem repulsed by certain body parts or their body in general.
  • Suffers from depression and engages in self harm. Some individuals also abuse drugs, alcohol, or laxatives.

If your child shows signs of an eating disorder, getting help is essential. Eating disorders can lead to heart and kidney problems or even death, and often coincide with other emotional illnesses, which can be just as harmful mentally as they are physically. Treatment is available to help with the individual’s emotional, social, and body image problems that cause eating disorders. Anad.org is a good place to get started in finding adequate treatment. There is hope in recovery. Your child can overcome his or her eating disorder.

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Eating Disorder Research Update

eating disorders

Be sure to understand when eating disorder risk factors become predictive. (photo credit:BigStockPhoto.com)

Research teams across the country and around the world are constantly pursuing research projects designed to help better understand eating disorders including the root cause, who is most at risk, and what treatments are the most beneficial.  For families affected by an eating disorder, keeping on top of this research is important as it can improve their understanding of a specific disorder and guide them in providing the support and assistance required to restore a person with an eating disorder to good health.  To help, here is an overview of one of the research initiatives published thus far in 2014.

Understanding When Eating Disorder Risk Factors Become Predictive

The factors that can increase the risk for developing an eating disorder are well known thanks to previous research initiatives but when those risk factors emerge and at what point they can be used to predict eating disorder development is less clear.  The goal of this study was to better understand how to use what we know about risk factors to do a better job predicting future disorder development.   The data used in the study was collected from a participant pool of almost 500 females who completed an annual survey for the 8 years spanning from pre-adolescence to young adulthood.   The survey tracked potential risk factor and eating disorder diagnosis information.

The results show that risk factors generally emerge in early adolescence and three of the risk factors emerging in the early teen years seemed to correlate to an increased risk of eating disorder development in the later teen years and in early adulthood.  These three factors are perceived pressure to be thin, internalizing thin as the ideal body type, and body dissatisfaction.  Of those three, increased body dissatisfaction in girls ages 13 to 16 was predictive of an eating disorder diagnosis within 4 years.  The other two factors only seemed to be predictive when seen in girls who were 14.  This indicates that prevention programs need to begin in early adolescence, these programs need to target girls dealing with increased body dissatisfaction, and that prevention efforts focused on 14 year old girls will be the most effective.

The ABCs of Children’s Mental Health

Mental Health Resources

Here are some great resources to help you understand the ABC’s of mental health (photo credit: BigStockPhoto.com)

May is Children’s Mental Health Month which is a great time to talk about where parents can find more information about the mental health conditions their adolescents may be struggling with. While there is no substitute for the expertise and information provided by a qualified mental health practitioner, this version of the ABCs can help parents learn more about the mental health conditions commonly seen in teenagers so they have the information they need in order to know when it is time to seek help, what questions to ask, and how to ensure their child or teenager gets the mental health support and services they need.

ADHD

Bipolar Disorder

  • Bipolar Disorder in Children and Teens: A Parent’s Guide from the National Institute of Mental Health
  • Children and Teens with Bipolar Disorder from WebMD.com
  • Bipolar Disorder in Children and Teens from the American Academy of Child & Adolescent Psychology
  • Children and Adolescents with Bipolar Disorder from the National Alliance on Mental Illness

Bullying

Cutting and Self Harm

  • Understanding Teen Cutting and Self Injury from Parenting.org
  • Self Injury and Cutting from the Mayo Clinic
  • Self Injury in Adolescents from the American Academy of Child & Adolescent Psychology
  • A Silent Cry for Help: Understanding Self Harm from Psychology Today

Depression

Eating Disorders

Generalized Anxiety Disorder and Panic Disorder

Obsessive Compulsive Disorder

  • Obsessive Compulsive Disorder in Children and Adolescents from the American Academy of Child & Adolescent Psychology
  • OCD in Children and Teens from the International OCD Foundation
  • Child and Adolescent OCD from the National Alliance on Mental Illness
  • OCD in Teens from Beyond OCD

Post Traumatic Stress Disorder

Suicide Prevention

  • Society for the Prevention of Teen Suicide website
  • Preventing Youth Suicide – Tips for Parents and Educators from the National Association of School Psychologists
  • Teen Suicide is Preventable from the American Psychological Association
  • National Suicide Prevention Lifeline – Available 24 hours a day, 7 days a week, 365 days a year at 1-800-273-TALK (8255)
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Are Cleanses the New Eating Disorder?

juice cleanse

Are juice cleanses the new eating disorder? (photo credit: BigStockPhoto.com)

Cleanses are healthy, right?  They are touted on major talk shows, endorsed by celebrities, and billed as a healthy way to lose weight and rid the body of toxins.  But are they actually good for your body?  And is the “cleanse culture” ushering in a new kind of eating disorder? To answer these questions, let’s start by looking at some of the most popular cleanses and the benefits they promise to bring.

  • The Master Cleanse – 10 day liquid diet consisting primarily of lemon juice, water, cayenne pepper, and maple syrup.  Promises rapid weight loss and toxin removal.
  • LemonAid 48 Hour Detox Diet – 2 day liquid diet consisting of a specific lemonade formula.  Promises a lighter, leaner you.
  • iZO JuiceFeast Cleanse – Liquid diet consisting of organic juice that people can do for any length of time.  Promises everything from quick weight loss to spiritual renewal.
  • 21 Day Clean Detox Program – 21 day program that includes specific shakes, supplements, and one small daily meal consisting of food from an approved list.   Promises to remove common food allergens, rebuild the body, and gain a better understanding of how your body reacts to certain foods.
  • Blueprint Cleanse – 3 day cleanse that features juice all day, two snacks, and a vegetarian meal at dinner.  Promises to relieve stress on the digestive system and alleviate toxins.
  • The Quantum Wellness Cleanse – 21 day program that eliminates alcohol, gluten, added sugar, caffeine, and animal products from the diet.  Promises to kick-start physical and mental wellbeing.

While many experts agree that short cleanses like the LemonAid 48 hour detox or the Blueprint cleanse may not necessarily deliver significant benefit, they also agree that extreme calorie reduction for a few days isn’t going to do any harm either.  But when this kind of extreme calorie restriction goes on for a week or more, concerns are being raised about how that is impacting the body.  But even doing something like the Master Cleanse for 10 days isn’t the real issue nutritionists and experts in this area are worried about.

The concern over the popularity of these cleanses is that when people, especially women, go through one of these programs and experience rapid weight loss from extreme calorie restriction or other temporary benefits, they can become obsessed with cleansing.  This can lead to going through a new cleanse every week or two.  Since most cleanses involve extreme calorie reduction and intake of a very limited group of nutrients, this healthy fad, when taken to extremes, can have serious health consequences.    Some have even raised concerns that this type of behavior may be developing into a new kind of eating disorder.

The National Eating Disorder Association (NEDA) defines an eating disorder as a serious emotional and physical problem that involves extreme emotions, attitudes, and behaviors around weight and food.  Given that definition, it is easy to understand why there are growing concerns about the cleansing craze.  NEDA has recently added a category of eating disorder to their website called Avoidant/Restrictive Food Intake Disorder that encompasses behavioral patterns where a person fails to take in enough food and experiences serious nutritional deficiencies but without the psychological factors seen with Anorexia Nervosa.  While not specifically related to cleanse craziness, this new disorder seems to encompass the problem that would result from extreme cleansing.

Eating Disorder Awareness Week

Eating Disorders

Do you know the warning signs that a loved one may have an eating disorder? (photo credit: BigStockPhoto.com)

When most people think of eating disorders, it is very likely that the image that pops into their mind features a young, emaciated girl.  But this is only part of the real story of eating disorders and something that the National Eating Disorders Association is working to change with its annual awareness campaign.

National Eating Disorders Awareness Week runs from February 23rd to March 1st this year which provides the perfect opportunity for everyone to increase their understanding of these debilitating and even deadly disorders.  There are millions of people in this country suffering from eating disorders but many go undiagnosed and untreated.  In part, this happens because of the shame and guilt many people struggling with these conditions feel because of their disorder.  It also happens because not everyone with an eating disorder looks like that girl many of you pictured.  People with eating disorders come in all shapes and sizes which is why it is so important to spread awareness to everyone, not just amongst those who have been diagnosed.

Here are some of the things you can do to help spread awareness about eating disorders this month.

1.     Educate Yourself or Someone Else

Many people have a very limited understanding of the two most well-known eating disorders, anorexia nervosa and bulimia nervosa and little to no knowledge about the other common eating disorders.  This means that we may not see the signs of struggle in someone we love or even in ourselves.  Understanding the basics of the four primary eating disorders is a great start.

  • Anorexia Nervosa – When a person participates in self-starvation, depriving the body of calories in order to become thinner.
  • Bulimia Nervosa – When a person goes through cycles of binge eating followed by activities like purging or excessive exercising to “make up for” for the binge.
  • Binge Eating Disorder – When a person participates in regular episodes of binge eating that is not accompanied by other behaviors intended to compensate for or get rid of the extra calories.
  • Eating Disorder Not Otherwise Specified (EDNOS) – Some people who struggle with disordered eating exhibit a range of symptoms that prevent them with being diagnosed with each of the three primary disorders above.

2.     Host an Event

The National Eating Disorder Awareness website has a ton of information you can use to host a fun, informative, or educational activity or event as part of the awareness week event.   One great way to get the message out is to host a screening of “Someday Melissa”, a documentary about eating disorders.   For assistance in planning your event, download NEDA’s Event Planning Guide.

3.     Share Your Story

Whether you post some thoughts on your favorite social media site or stand up in front of a crowded room, sharing your own eating disorder story is one of the most powerful things you can do to raise awareness and make a difference in other people’s lives.

4.     Post About the Problem

Take to social media to help spread the word about eating disorders.

Are Our Teenage Boys Suffering from a Silent Epidemic?

eating disorders males boys

Girls aren’t the only ones who struggle with eating disorders. (photo credit: BigStockPhoto.com)

Many of those with eating disorders suffer in silence, afraid, ashamed, and unable to ask for help.   The National Association for Anorexia and Associated Disorders (ANAD) estimates that only 1 out of every 10 people with an eating disorder ever receive treatment which is more than tragic when you consider the dangers these disorders create.  And new research indicates that there may be more people with eating disorders suffering in silence than previous estimates indicated because the problem is affecting males more often than believed.

The study was conducted by a team of researchers from different medical institutions and was published in the JAMA Pediatrics journal.  The intent of the study was to determine if males who experienced disordered eating were more likely to experience other problems like depression and obesity over time.  The study ran from 1999 to 2011 and involved more than 5,000 teenage males from all over the country.

What the research team found may result in a broadening of how we think about disordered eating and the classification of different kinds of eating disorders that are more specific to males.   The current classifications which include Anorexia Nervosa, Bulimia, Binge Eating Disorder (BED), and Eating Disorder Not Otherwise Specified (EDNOS) are seen in both men and women, but are more likely to be seen in women whose primary concern is often thinness.  Because teenage males have different concerns about their body than teenage girls, males may exhibit different kinds of disordered behavior which is neither classified nor diagnosed.

It also showed that almost 20% of teenage males are extremely concerned about their body and that these teens are more likely than their peers to engage in dangerous behavior including the use of alcohol, drugs, and supplements.    Most experts agree that about 1 in every 10 people with an eating disorder is male but according to the study’s lead author, Alison Field, this ratio is likely much smaller because the current criteria for diagnosis center on symptoms displayed by women which are proving to be different than those experienced by men.

One of the primary differences between males and females with disordered eating highlighted in the study results is what each gender is trying to achieve.  For women, it is generally thinness which leads to disorders like Anorexia Nervosa which causes people to stop eating and Bulimia which results in a cycle of extreme overeating followed by purging.  For males, the focus is more on masculinity, on building musculature which leads to different behaviors.  For example, almost 8% of the study’s 16-22 year old participants admitted to using some form of supplement, growth hormone, or steroid in an effort to attain the desired result.  Field points out that this type of behavior may be the equivalent to the binging and purging seen in women who have bulimia.

The signs and symptoms of eating disorders in males are the same as those in females at this time, which means many males will remain undiagnosed.   Perhaps one of the most positive outcomes of this new study will be a change in how we think about disordered eating and men.

 

Eating Disorders and Depression

eating disorders depression

Do you know the connection between eating disorders and depression? (photo credit: BigStockPhoto.com)

Although it isn’t clear exactly how eating disorders, like anorexia nervosa or bulimia, and depression are related, they often seem to go hand in hand.  While there is some scientific evidence that depression may increase the risk of developing an eating disorder, there is also evidence that the reverse can be true, that have an eating disorder can increase the risk of developing depression.

This link with depression seems to be apparent with the three primary eating disorders to varying degrees. With anorexia, in some circumstances the physiological changes resulting from the disorder can lead to depression.  In others, the underlying cause of the eating disorder may be depression and anxiety.   In those with binge eating disorder, the disorder itself can cause feelings of guilt and shame that impact self-esteem and can contribute to or worsen existing depression.

The signs of depression in people with eating disorders are the same as the signs for anyone with this condition including:

  • All encompassing feelings of sadness, hopelessness, and/or unhappiness
  • Losing interest in activities
  • Irritability
  • Quick temper
  • Difficulties sleeping
  • Changes to sleeping patterns or habit
  • Loss of appetite
  • Changes in eating habits
  • Suicidal thoughts or tendencies

Mental health providers use the same diagnostic tools for determining if someone with an eating disorder has depression as they would for any patient.  But when it comes to treating the two co-existing conditions, some challenges present themselves.

In order to be effective, a treatment approach for people that have an eating disorder and depression must address both disorders in order to be successful.  This is one of the reasons it is so important for people who are suffering from both to get both disorders diagnosed.  If treatment focuses solely on the eating disorder or solely on the depression, progress and remission are unlikely in most cases.

Depression and eating disorders are generally treated with anti-depressant medications, cognitive behavioral therapy(CBT), and/or education on healthy eating habits. Those with binge eating disorder may also be treated with an anticonvulsant medication that has proved to be effective at reducing binge episodes.   CBT is a common treatment option for depression but it is also proving to be very beneficial for those with anorexia, bulimia, and binge eating disorder.

The fastest results come when medication is used but a medication only approach carries a higher risk for relapse.  Those who are treated only with CBT are less likely to relapse but it takes time to see results.  However, when used together, these treatment options can help those with these conditions overcome both disorders.

Treating eating disorders with underlying depression is possible but for the greatest chance of success, all mental health conditions including depression, anxiety, etc. must be diagnosed and the treatment plan implemented must be tailored to the individual’s needs.

Current Research Into Eating Disorders

Here are some quality resources for Eating Disorders. (Photo Credit:BIgStockPhoto.com)

Here are some quality resources for Eating Disorders. (Photo Credit:BIgStockPhoto.com)

Eating Attitudes and Concerns Research Study

This study is being conducted at Bowling Green State University and seeks to better understand the relationships between eating attitudes and concerns and performance on certain tasks related to vocabulary.  Women ages 18 and up are welcome to participate in the study and participation can be conducted completely online.  The study, which is completely anonymous, is expected to take between 20-40 minutes and volunteers will be entered in a drawing for one of 2 $50 gift cards from Amazon.com.  To participate in the study, click here.

Brain Activity Study in Women with Bulimia

This study, conducted by researchers at Drexel University, seeks to better understand the differences in brain activity between women with bulimia and those who do not have the condition.  The study is open to right-handed women aged 18-45 who are being treated for binge eating and purging and can visit the research team in Philadelphia.  For more information and to see if you qualify for the study, contact Laura Berner or Alyssa Matteuccicall by phone at (215) 762-1850 or e-mail the research team at fNIRSipStudy@drexel.edu.

Predictors of Anorexia Nervosa Preoccupation and Ritual Severity

This study is being conducted at Fordham University and seeks to learn more about the risk factors related to Anorexia Nervosa to better inform treatment providers.  In order to participate in the study, volunteers must be between the ages of 12 and 18 and must be currently receiving treatment for anorexia nervosa or have previously been professionally treated for the condition.  To participate, visit the survey here.

Eating Disorders Research Study

This study is being conducted at the Mount Sinai Eating and Weight Disorders Program and seeks to examine the differences in attention patterns, flexibility of thought, and problem solving styles between those with eating disorders and those who do not have these conditions.  Participants can be between the ages of 12 and 60 and will include those with eating disorders and those without.  In order to participate, volunteers will need to be able to visit the centers twice for 3-4 hours each.  For more information, contact Adrianne Flores at the Mount Sinai Eating and Weight Disorders Program at (212) 659- 8724 or Adrianne.Flores@mssm.edu.

Anorexia Research Study

This study is also being conducted at Mount Sinai and seeks to determine if there is a relationship between the level of sex hormones in adolescents and young adults and the presence of obsessive/compulsive disorders like Anorexia Nervosa.  Participants must be female between the ages of 12 and 22, cannot be diagnosed with Anorexia Nervosa, and must be available for two in-person visits lasting about 2 hours each.  For more information, contact Adrianne Flores at (212)659-8724 or by email at  Adrianne.Flores@mssm.edu.

Family-Based Treatment for Anorexia Study

This study, being conducted at the University of Iowa, seeks to investigate the differing experiences of parents who have participated in family-based treatment programs for Anorexia Nervosa.  The research team is looking for 25 parents who had a child between the ages of 10 and 18 who previously participated in family based treatment.   Participants do not need to be local to the University to participate.  For more information, contact Joanna Wiese a 563-676-2500 or joanna-wiese@uiowa.edu

Signs Someone You Love is Struggling with Anorexia

If you suspect someone you know may suffer from anorexia, check out these warning signs (photo credit: BigStockPhoto.com)

If you suspect someone you know may suffer from anorexia, check out these warning signs (photo credit: BigStockPhoto.com)

When a person has anorexia nervosa, they are starving themselves and not providing their body with the basic nutrients and calories needed for survival.  When this happens for an extended period of time, the body takes drastic action to conserve energy and preserve life.  Unfortunately, these defensive mechanisms can have very serious long-term health consequences.   The challenge for parents, teachers, coaches, and teens is to know when someone they care about is in trouble so that help and support can be provided in an effort to avoid these negative consequences.  While the main sign that someone is struggling with anorexia is their appearance, there are other signs that can be seen before the disorder progresses to the point that it is visibly noticeable.

1.     Dramatic Weight Loss

One sign that someone you love may be in trouble would be a dramatic reduction in weight within a relatively short period of time.  Healthy weight loss for those who are overweight is generally considered to be 1-2 pounds per week.  If someone is losing significantly more than that, they may be struggling with anorexia or another eating disorder.

2.     Obsession with Food

Many people with eating disorders exhibit a preoccupation or type of obsession with food.  This can include obsessively weighing everything before it is eaten, fanatically tracking weight, food, calories, fat, or other related information, or going on extreme diets. Other signs of food obsession can also include collecting recipes, watching TV cooking shows, and looking at internet food sites.

3.     Distorted Body Image

It is not uncommon for people with anorexia to have a distorted image of what their body looks like.  This can result in very thin people complaining about being fat or obsessively talking about the need to lose weight no matter how much weight they lose.  While it may seem like a strategy to get attention, in many cases the image the person sees when they look in the mirror does not match the reality.

4.     Unusual Eating Habits

Some people with anorexia exhibit unusual eating habits.  This can include things like avoiding entire food groups, eating food in a certain order, denying that they are hungry, and excessive chewing.  People who avoid eating any of their meals with other people or who participate in meals but don’t really eat anything are also exhibiting unusual eating habits consistent with anorexia.

5.     Obsessive Exercise

When people with anorexia do allow themselves to take in some food, they can become obsessed with burning off those calories as soon as they eat them.  People who have become obsessive about exercise as part of their anorexia will be rigid in their adherence to their workout routine.  They will exercise regardless of weather, illness, or injury.  The need to rid themselves of the calories they have taken in can be more important than anything else.

6.     Social Withdrawal

Another behavior that many people with eating disorders like anorexia display is social withdrawal.  They may stop participating in activities they previously enjoyed or stop spending time with friends or loved ones.

Anorexia is a serious eating disorder that can lead to long-term health consequences and even death.  If you suspect someone in your life is suffering from anorexia, reach out and get them the support they need.

 

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