Disordered Eating and Eating Disorders

A parent's guide to promoting positive eating habits and addressing concerns

Apr 23, 2025

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Navigating the world of healthy eating can feel overwhelming, especially with the increasing awareness of disordered eating and eating disorders.

This week on the Raising Good Humans Podcast, we recorded a live episode with the Mount Sinai Parenting Center. I had the privilege of speaking with Dr. Tom Hildebrandt, clinical psychologist and director at Mount Sinai’s Center for Excellence in Eating and Weight Disorders.

Let’s start by clarifying the distinction between disordered eating and eating disorders. Disordered eating refers to patterns that deviate from healthy eating habits that may cause physical or mental distress, often triggered by stress or emotional challenges. In contrast, an eating disorder becomes a primary source of distress, proving difficult to change even with the individual's intent. Sometimes, but not always, disordered eating is a precursor to a more severe eating disorder, which is why early intervention is crucial.

As Dr. Hildebrant explains, the research supports the idea that establishing healthy habits early in life is paramount. Disordered eating patterns can emerge even in young children, reflecting their environment and stressors, but by early adolescence - when children have greater autonomy over their choices - kids are particularly vulnerable, and eating disorders typically surface.

Here are the top overall tips on creating that healthy environment:

Family meals: Eating together allows you to observe your children's eating habits, model best practices, and provide feedback in a supportive context. If you know what patterns are emerging, you can help to intervene early, AND you can create a positive association around food through conversation and connection.
Decide on the menu: Don’t allow children to make choices based on “what they are in the mood for,” and instead focus on offering a balanced menu that you feel good about at every meal. They have time to make good decisions for themselves, but first need the consistency and wisdom of your choices.
Regular eating: Regular meals, including breakfast, are crucial. These establish healthy patterns and help regulate energy levels and eating decisions. Research shows that children eating 3 meals a day and one snack, are far less likely to develop overweight or underweight eating disorders.
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One key takeaway was Dr. Hildebrandt’s point around autonomy. We want to give autonomy support but often forget that our children may not developmentally be able to make good choices based on their needs. Creating an environment where they always get to choose what they want can lead to becoming a short-order cook, and children will often choose based on palatability, or seek attention and control by making specific demands. As children get older and have more autonomy in the world, we can begin to notice signs that they are on a healthier path, and can make better independent decisions, but it isn’t at a specific age. There has been an uptick in eating disorders and disordered eating, partly due to the increased autonomy and food environment influenced by delivery services, and this “always on” availability. The messaging in this environment is that your preference dominates the decision, which can be challenging for a young brain. For this reason, avoid letting teens order food independently until you are confident that the rest of their choices and habits are sensible and healthy.

Keep in mind that mealtime should be enjoyable. Avoid making food the focus of the conversation, and avoid labeling foods as "good" or "bad." Focus on balance and variety - moderation is always the answer in the literature. One suggestion from the episode is to think about having an “add mindset” instead of a “delete mindset.” Instead of restricting, encourage adding healthier options to compete with less healthy choices. For example, add fruits and vegetables to cookies rather than just saying "no" to cookies.

Now, we know that parents do not fully control the food environment around our children. Diet culture, 24-hour access to easy ordering, and weight loss medications like GLP1s are changing the way our children think about and consume meals. However, their most powerful influence is still your connection. Dr. Hildebrant suggests that when you notice that something may be off for your child, you talk about it. Express your concerns with compassion and without judgment - but express them. He compares an adolescent's struggle with dieting or disordered eating to a struggle with binge drinking. Just as parents wouldn't ignore or enable a child's dangerous drinking habits, they shouldn't dismiss harmful dieting behaviors. Both can be serious and require intervention, even if it means having difficult conversations, or setting firm boundaries. As we know, a teenager's developing brain isn't always equipped to make safe choices.

Dr. Hildebrandt suggests starting with the phrase, “I know this is not your fault, but it is our responsibility.” I’m including a script he uses in the episode below because I think it captures this discussion so well:

“This is not your fault, but it is our responsibility. I don't blame you for having this issue, and I don’t think it is your fault. I do know that it's not good for you and I can see that you’re in distress. It's my responsibility as your parent to make sure that we put you back on a path where you can thrive in your life, as opposed to being in this situation, and so we're going to do that. We are gonna take responsibility for it, and it'll be hard. We are going to do things that are uncomfortable. We are probably going to have conversations like this that we don't want to have, but we are going to have them because I care about you so much that I would rather you both hate and respect me for standing up to this bully in your head, that is either making you eat too much or not enough, than do nothing at all.”

For so many of us, unhealthy eating habits emerge around self-soothing. If your child is self-soothing with food, address the underlying emotional needs through conversation, and offer alternative ways to cope with stress. You can say something like, “This is not about the cookies, but instead about what you’re not telling me. I don’t care if you eat cookies, but if you need alternative ways to handle stress, I’m here to help.”

Even with open communication and the best of relationships, it is also true that our teens can make talking about specific weight concerns or body issues VERY difficult. Dr. Hildebrandt recommends that you start by listing all of the things that are going well with your child first, and then adding any concerns about their weight or eating. This may go something like, “You are sleeping well, doing well in school, have a great social life, are getting along with all of your friends and taking care of yourself in so many ways, and I’ve noticed that your weight is also going off your growth curve. Is there anything we can do there to support you to get back on line?” Remember that regular eating is the simplest but most difficult prevention strategy to implement. If your child eats regularly, the likelihood of developing weight problems is very low.

So, where do we go from here? Recent research is shifting the understanding of eating disorders, suggesting they are not solely psychiatric conditions but also have significant metabolic components. Studies, particularly in genetics, have revealed that many genes associated with restrictive eating disorders are related to metabolism, not solely brain function. This perspective reframes eating disorders as potentially having a biological basis, similar to metabolic illnesses like diabetes, which could reduce stigma and shift treatment approaches.This makes their prevention and treatment about responsibility, not blame. That feels like a better approach for parents everywhere.

There was so much to discuss and so much more to think about. For more information on disordered eating and eating disorder treatment, visit Dr. Hildebrandt’s website here.

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