In most junior and senior high schools, students are dieting even though, on average, they are not overweight. “I always wanted to be the good girl. Good girls are skinny and happy. The bad girls are the fat ones,” answered an eleven-year-old when asked why she starved herself to the point of hospitalization.

Dieting is the most common behavior that leads to an eating disorder. Experts claim more than a third of normal dieters develop an eating disorder (ED). The majority of individuals with eating disordered behaviors report that they engaged in dieting prior to developing an ED. Nonetheless, in the U.S., 50 billion dollars plus is spent on dieting each year. TIME magazine reported that 80 percent of all children have been on a diet by the time they reach the fourth grade. One study stated that almost half of nine to eleven-year-olds are “sometimes” or “very often” on diets. Over 80 percent of their family members are “sometimes” or “very often” on diets. Note the connection!

Otherwise healthy teenage girls who diet regularly show signs of malnutrition, researchers have found. Dieting can cause teenagers serious harm, potentially preventing them from developing properly. Calcium deficiency is a large concern. Typical warning signs are fear of weight gain, frequent dieting, over-exercising, laxative abuse, loss of menstrual period, and binge eating usually followed by purging (a bathroom visit).

For the anorexic, it is easy to come up with an excuse for not eating. “Thanks, but I have an intolerance to (whatever is being served)” can be used to avoid pretty much any type of food situation. They may also say, “I ate before I got here.” Or, “I’m going over to my boyfriend’s home and need to save my appetite.” While these excuses are used to cover up a potentially fatal illness, their friends are impressed by their self-control. They don’t understand the complexities of an ED and the psychological and physical inability to overcome it. Far too often friends and family of anorexic individuals are oblivious to their suffering. If the illness hasn’t been diagnosed and acknowledged, it may go unrecognized. This is particularly true in the early stages of an ED.

To us it seems normal to limit food intake from time to time. The difference may be in how often these excuses are used and in knowing the person well enough to discern if they are actually a healthy, fit person looking to maintain a healthy weight, or a person who is sick with a very serious ED looking to lose weight unrealistically and unhealthily.

As a youth leader, if I don’t have a personal relationship with this hurting teen, I’ll probably miss the symptoms. If I am close to him or her I have a better chance of identifying a red flag. If I believe a certain behavior is a red flag it is important I speak to that teen in confidence and in love about my concerns: “I’m concerned because I see…do you think this might be a problem?”

For the bulimic, there is the red flag trip to the restroom immediately after a eating a large amount of food. That combined with other typical signs such as sores on the knuckles and fingers, puffy eyes and facial features, and sour smelling breath, may be a give-away. Hovering around the appetizers or a buffet line you will find people suffering from bulimia or binge eating disorder (BED) because they cannot control their eating. You may think that the person who is scarfing down all of food has BED, but in actuality the binge eater often does the majority of their bingeing in private. This person may be bulimic.

Although bulimia is not typically thought of as being as dangerous as anorexia, it comes with its own set of problems. Bulimics are generally more difficult to pinpoint because they are not getting any attention for their willpower or ability to stick to a diet like the anorexic. On top of that, there is nothing glamorous about vomiting and other methods of purging. Bulimics may be able to hide their struggle with their eating disorder for years before the physical effects become obvious to the untrained observer. In each of these cases, these people don’t understand the depth of their suffering and their need to eat to fulfill a psychological and spiritual emptiness. They need help and understanding.

Warning signs may be discreet. Warning signs, such as hiding food or compulsive exercise, may not be as apparent at church or school as they are at home. However, if a student’s schoolwork and grades begin to suffer, or if he or she is increasingly tired and lethargic, or if he or she begins wearing roomier clothes, even on warm days, there may be larger issues at play than just “normal teenage stuff.”

The good news is that treatment is available and can be extremely effective in helping teens deal with their eating disorders. Observant and caring friends and family should share their concerns first with their loved one. If this is not well received, it still does not hurt to contact an eating disorders specialist or discuss your concerns with a medical physician. They can provide contacts and information for friends and family members to help their loved one get the assistance they need to overcome their ED. While they may be unreceptive at first, often the ED is a cry for help and eventually they will take the help that is offered. Above all, don’t think that these problems are unimportant, a phase, or something that will go away on their own. True eating disorders are a much deeper issue than food.

Red Flag Alert! Like thousands of teens, Lilly was consumed by a crippling obsession with her weight that began as a need for control when she was twelve. Gripped by this monster, she spent her days surfing pro-anorexia websites, hiding the truth from her family and friends. The eating disorder took over every aspect of her life until, at sixteen, she was hospitalized. Doctors warned her parents she might die. Lilly’s parents said they never saw it coming. The signs were there, but like many parents they had no reason to look for the red flags. The most obvious warning signs of eating disorders involve drastic change in eating habits and body image. The less obvious signs may be disguised:

• Does she/he seem to have an intense fear of gaining weight or becoming fat, especially if she/he is underweight or of normal weight?
• Does she/he repeatedly compare herself or find fault with her/his appearance?
• Does she/he talk about her/his body negatively, having a distorted body image?
• Does she/he talk about being teased about her/his weight?
• Does she/he think that if she/he was skinny instead of fat, then she/he wouldn’t be teased anymore? Or being skinny will “make me happy?”
• Has her/his eating habits changed? Has she/he lost interest in eating?
• Does she/he solely eat low-fat foods and regard other foods as “bad?”
• Does she/he pick or nibble or tear or cut the food into teeny-tiny pieces?
• Does she/he eat only certain foods or eat at specific times or eat alone?
• Does she/he skip meals, or make excuses to get out of eating, or say, “I have already eaten.”
• Is she/he preoccupied or obsessed with diet products, counting calories, food grams and nutrition?
• Has she/he taken up smoking to suppress appetite and relieve stress?
• Is there evidence of a large amount of empty food packages or laxative packages, or excessive caffeine use?
• Does she/he over-engage in sports, such as jog constantly or exercise (in front of the television) for long periods of time?
• Is she no longer menstruating?
• Is she/he more withdrawn than usual? Has she/he suddenly isolated?
• Does she frequently study cookbooks but never actually eats what she makes?
• Does she/he eat alone, at night, or in secret?
• Does she/he hoard high-calorie food?
• Does she/he avoid social situations that involve food? For example, she/he avoids the school cafeteria at lunch or the coffee shop or diner where you usually meet on weekends.
• Does she wear baggy clothes or multiple layers in an effort to hide dramatic weight loss (or she may be cutting herself)?
• Does she/he compete with others about food intake? If she proudly says she only had a diet soda for breakfast and half an apple for lunch, that’s a red flag.
• Does she/he constantly shiver or have blue fingers, due to intolerance of cold due to loss of body fat?
• Does she have pasty looking skin, or hair loss or extra hair growth on the face and arms?
• Have you noticed broken blood vessels in the eyes or wounds on the upper hand surface and knuckles caused by excessive purging as a result of bulimia?

Eating disorders affect dental health in a number of ways. The most noticeable are acid reflux effects. Symptoms include swelling of the cheeks and jaw, tooth and gum sensitivity, tooth decay, tooth discoloration, and halitosis (bad breath).

Realize this teen is in a lonely place where all that matters is her or his weight and the struggle to be thin. This is her or his way of controlling life–the anxiety and stress. They don’t see the underlying reason or symptoms. They need to learn new coping strategies and professional counseling can usually provide this. Locate a professional who specializes in eating disorders. Family therapy is one mode of treatment that has shown to have good results.

What you can do: EDs often onset during the teenage years, so it is crucial to address them quickly. Early intervention is important. But don’t ambush her or him with well-meant but overly direct or critical questioning. Getting good information is an important first step.
• Youth leaders should also be aware of their own eating behaviors. For example, be conscious of setting a good example by avoiding diet products, negative body image talk and comments either about yourself or others, and discussions of “good” or “bad” foods.
• Recognize that the person with an ED will likely feel ashamed or embarrassed that you have uncovered his or her secret. Experts suggest the following tactics:
• Express your concern, but be prepared for all possible reactions. These may include denial, anger, hostility, defensiveness or, perhaps, relief.
• Be firm but caring. Be prepared to explain why you believe the person has an ED. Denial is difficult in the face of hard evidence.
• Read as much as possible about the subject. This will allow you to help the person understand his or her problem.
• Most important: be willing to listen. Love on this person and show your support instead of focusing on eating behavior.
• Stress that you care deeply and would like to help in whatever way you can. At this point you may need to bring your concerns to the parent(s). If feasible, talk to the parent(s) about your concerns and the need to seek counseling. You may need to be encouraging, caring and persistent to convince the parents or teen to get help. If agreeable, you can be pro-active and offer to help them find the right treatment center and arrange an appointment. People with EDs often need lots of understanding and support to stick with treatment once started.
• Remember to take care of yourself as well. It’s easy to feel overwhelmed and completely absorbed in this crisis.

Click here for more information and a list of resources.

Next issue: Part Two: Debunk the Myths—Learn the Different Causes of Eating Disorders

Kimberly Davidson received her M.A. in specialized ministry from Western Seminary, Portland, Oregon. She is a board certified biblical counselor, personal life coach, speaker and founder of Olive Branch Outreach, a ministry dedicated to bringing hope and restoration to those struggling with eating disorders and body image. Kimberly volunteers in student ministries and youth education outreach. She is the author of four books, including Torn Between Two Masters: Encouraging Teens to Live Authentically in a Celebrity-Obsessed World.