By: Sara Gonet, MS, RD, LDN, CEDS-C
Over the past 12 years of treating patients with eating disorders, more than half have been children and teens between the ages of 10-17 years old. Working with this age group means that I spend as much if not more time with their parents and caregivers helping them understand their child’s diagnosis while navigating first steps of a treatment plan and beyond.
Caregivers often come in with feelings of overwhelm and helplessness while filled with questions: “Did I cause this?” “How long will treatment take?” “Why is weight gain required if she is already experiencing so much body image distress?” “He is not feeling hungry, there is no way he can eat this much.” It is the dietitian’s role to provide comprehensive education to set the stage for parents’ success.
In this article, I will highlight several key topics that parents can expect their child or loved one’s dietitian to cover throughout the eating disorder treatment process. It is important to note that caregivers can be anyone supporting a loved one at any age during their recovery process. It is very common for RDs at our practice to work with our clients’ family members and partners.
Five Essential Insights for Caregivers from an Eating Disorder Registered Dietitian:
1.) Parents do not cause their child’s eating disorder. In fact, parents play a vital role in their child’s healing process. Eating disorders are serious illnesses that are caused by biological, psychological, environmental and social factors.
2.) Eating disorders don’t look the same from person to person. Because of that, your child’s dietitian will conduct a thorough assessment and develop tailored treatment recommendations.
For younger children and adolescents Family Based Treatment (FBT) at home on an outpatient basis is the likely first line of treatment. (More on FBT in our next Parent Support Series). Your child’s treatment team will evaluate the effectiveness of FBT as you go. If your child isn’t able to make progress with weight restoration, renourishment, and reducing eating disorder behaviors at home, a higher level of care is often the next step. This doesn’t mean parents have “failed,” it just means the child’s eating disorder is strong and you and your child need more help. I sometimes use an analogy: if your child had cancer, you’d probably want them to receive appropriately assertive treatment to make sure they have the opportunity to heal. An eating disorder is similar in some ways: your child has an illness that they did not choose and it deserves the right level of care for the best chance of recovery. Your dietitian, along with other treatment team members will guide you.
| Levels of Care | Description |
| Outpatient (OP) | Weekly therapy, nutrition and medical monitoring |
| Intensive Outpatient (IOP) | 3-4 hours/day, several days per week |
| Partial Hospitalization (PHP) | 6-8 hours/day, 5 days per week. |
| Residential (RTC) | 24-hour structured care for continued recovery |
| Inpatient (IP) | Hospital-level of care for medical stabilization |
3.) Full weight restoration is essential for physical and psychological recovery. Your child’s dietitian will review historical growth curves to determine their expected body weight (EBW). Weight restoration can be one of the most challenging parts of eating disorder treatment for your child, and seeing their distress can be just as distressing for parents. I have had many teen clients ask to stop weight restoring before they’ve reached their EBW, because they’re scared and exhausted and don’t feel they can do it anymore. It would be so easy at this moment for their parents and treatment team to say “yes, let me take away that anxiety for you and let you stop here.” However, your dietitian would not be providing evidenced based care for your child’s recovery if they did that! Eating disorder recovery often involves some temporary discomfort in exchange for long-term benefit.
Why is complete weight restoration so important?
*Brain Healing—research shows that the brain does not fully normalize until full nutritional rehabilitation is achieved.
- Improves cognitive flexibility
- Reduces food obsession and intrusive thoughts
- Decrease anxiety and rigidity
- Improves emotional regulation
*Relapse risk is higher without full weight restoration—studies consistently show that individuals discharged at lower weights have higher relapse rates. Being even a few pounds under EBW range can:
- Maintain eating disorder thoughts
- Reinforce fear of weight gain
- Preserve body image distortion
*Hormonal, metabolic and bone/organ recovery
- Resumption of regular menstrual cycles (if absent)
- Reduces elevated stress hormones (cortisol)
- Restores estrogen and progesterone balance
- Normalizes testosterone levels
- Improves bone density levels, reducing risk for osteoporosis and stress fractures
- Normalizes metabolic rate
- Promotes regular digestion
- Hair, skin and nail health
The last few pounds of weight restoration often makes the difference between temporary remission and long-term freedom.
4.) Modeling neutral language about food and body: The other day I noticed my toddler, who was sitting next to me on the couch, look at how I was sitting, then she crossed her legs and put her hands in her lap just like I was doing. Your children, even at the youngest age, are watching your every move and listening. Your dietitian will coach you on how to talk about food and bodies in a neutral way, refraining from talking about food as “good” or “bad”/ “unhealthy” or “healthy” and comments about bodies in general.
5.) Seek Support. You’ve heard the saying, “you can’t pour from an empty cup.” Eating disorders impact the entire family system. Recovery is a rollercoaster and one of the hardest roads you may walk down. You truly won’t be able to help your child if your tank is empty. Attend your own therapy sessions and support groups for loved ones.
With the right support, guidance and tools the difficult journey of eating disorder recovery can be one described as hope, healing and restoration.
“I honestly don’t know how we would have made it to recovery without the specific guidance of an ED dietitian. It is so overwhelming to be the parent of a child with an ED; our dietitian helped me navigate the process by educating me on the complex disorder, providing a very clear plan for my child’s nutritional needs and weight goals, and following us regularly. The ED needs very clear boundaries so it can’t win, and the dietitian was instrumental in helping me learn how to set those boundaries with my child.”–Parent of a former client
Favorite Parent and Caregiver Eating Disorder Groups and Resources:
- Understanding Eating Disorder Care: An Introduction for Parents & Caregivers
- Parent and Partners Workshop
- F.E.A.S.T
- Meal Support Video
- Eva Mugsby
- The Alliance for Eating Disorders Groups
- The Parent’s Guide to Eating Disorders, By Marcia Herrin