Expert: Ryan Hale - 1/25/2010

Question
I a 16 yr old daughter who is back to counting calories and at a very low weight 5'5" ..from 135 on 10/27 down to 112 christmas day. This is her second time doing this. She went through it at age 13 and once we caught on we immediately were able to turn it around. This time its been harder. She has yet to gain one pound and continues to lie about what she is eating. She is a Cheerleader and I am concerned about her getting hurt due to extreme weight loss. Is this something she should stop until she is up to a healthy weight? Beginning in the next few months they start rigorous training. We also believe her cheerleader friends are doing the same thing which provides peer pressure,  should we take her out of that situation?
thanks,


Answer
Laura-  I always tell parents of children who are experiencing this  (especially girls) and on a sports team, that if there is one, there is another.  In the sports setting, it is very, very uncommon that this is taking place in isolation.  So, it would surprise me if there WASN'T another girl(s) who was doing the same thing.  

Eating disorders often follow a predictable storyline: sometimes there is a history of abuse (physical or sexual), sometimes there are pressures (such as sex) being placed on the teen by a boyfriend or peer group, often, they come from a family that is very perfectionistic with nearly impossible demands on their appearance, conduct or school work, often one of the parents is unavailable emotionally.  Very often there are issues of depression or anxiety that the person is trying to alleviate by feeling anything other than the feelings of depression or anxiety (the way an alcoholic would try to "numb" their feelings).  These are commonalities is the "typical" cases.  

In the sports context, often what makes someone a good athlete (willingness to put up with discomfort, eagerness to please coaches or teammates, the idea of setting higher and higher goals or never being as good as they can be, conformity to an ideal body image in activities such as dance, diving, gymnastics, etc) make a good setting for an eating disorder.  There is hope in the exercise setting though, that is competition.  If the athlete can get with a nutritionist and a counselor and their way of thinking about food can change to that of seeing food as fuel and as feeding their activity... food can make them better in other words, then often they can turn it around.

It is very uncommon to treat eating disorders without treating the whole system:  what's going on in the family?  who are her friends?  who is her boyfriend or romantic interest?  what's going on in school?  what's going on with this team she's on?  

Believe it or not, there are coaches who encourage this kind of thing either explicitly by having weigh-ins or body image expectations, or implicitly by the subtle messages they send when they talk about someone being fat or going around at team dinner and having everyone turn in their dessert off their plate.  Either way, talk to the coach and athletic director.  Eating disorders have the highest rate for death of ANY mental disorder (even depression), so it's difficult to overreact. You need to get involved.