Disordered Weight Control Behavior

Being a teenager is hard, for both teens and parents. I have two young daughters myself, and can say with all honesty that I am anxiously anticipating what the teen years have in store for us, especially as they try to figure out their self image. Magazines, movies, and social media are ever present in our lives and they are often promoting unrealistic images of beauty that are not obtainable. As a family physician and a father, I want to help guide my girls to a healthy self image while also respecting their independence and privacy.

To help prepare me for the teenage years, I interviewed Dr Monica Wang, assistant professor at the Boston University School of Public Health who specializes in childhood obesity and disordered weight control behaviors. Below is her guidance on how to recognize and care for teens who have disordered weight control behaviors.

Dr. Wang: Disordered weight control behaviors include self induced vomiting, taking laxatives, and using diet pills. This is different than eating disorders, such as anorexia or bulimia, which are clinical disorders that require a strict set of symptoms to be diagnosed. Disordered weight control behaviors do not need a diagnosis and are more prevalent in the general population. And, simply because they don’t require a diagnosis doesn’t make them any less harmful.

Dr. Wang: These behaviors can be hard to find, but there are some common red flags such as:

• Spending a lot of time in bathroom (concern for self-induced vomiting or laxative use)
• Excusing themselves frequently after eating
• Avoids the topic of eating or food

Other behaviors to be concerned about are disordered eating (extreme fasting, skipping meals, and extreme calorie counting or restriction) and excessive exercise (prioritizing exercise to the extreme as opposed to including exercise as part of a balanced lifestyle). It can be hard to distinguish these two behaviors from healthy weight management, but you should start to suspect something is wrong if your teen starts to avoid meals, gets easily upset if they can’t count calories, or their diet/exercise is significantly impacting their quality of life (like skipping out on social events with friends and family to instead go exercise, continuing to exercise if they are sick, or having an obsessive exercise regimen).

Dr. Wang: Adolescence is a time of rapid growth and transition, and also when their peers are highly scrutinizing one another. This can create a fear of being judged and criticized, and no teen wants to be excluded from their peer groups. Young adults are looking for a quick fix to get to a certain body size. Diet pills and vomiting are often seen as easy options because it is something they can control with the lure of fast results.

Dr. Wang: The stereotypical image we have in our mind of people who have eating disorders are thin white, young women, when in reality the picture is different. Disordered weight control behaviors are actually more common in overweight and obese teens as they engage in these unhealthy behaviors to control of their weight. As ethnic minorities in the U.S. are more likely to be overweight (particularly African, Latino, and Native Americans), we in turn see more disordered weight control behaviors in these subgroups. Other high risk groups include sexual minorities (e.g., LGBT youth), teens who may be non-gender conforming, and teens who are bullied. These behaviors may become a coping strategy to gain greater control in their life as well as to deal with the pain and struggles they may experience as victims of bullying, harassment, or discrimination.

1. Non-judgmental inquiry: If you notice your child making extreme, unhealthy adjustments in their eating behaviors, bring it up gently. Ask how their diet makes them feel. Ask what their goal is, why they are doing it and how you can support them. Approaching the subject in a non-judgmental way increases your chances of partnering with your child to help them find better ways in achieving their goal. Also explore other factors like bullying and feeling secluded from a group – you may uncover something new which may need more attention.
2. Engage: Research has shown that teens who have regular family dinners are less likely to exhibit disordered weight control behaviors. It doesn’t have to be dinner, as any time is a good time to connect with your teen, but having it regularly scheduled is more beneficial. With the advent of smartphones, you can even Facetime with your child if you have to be away on travel. If a parent is not available, then sign your child up for after school programs like the Boys and Girls Club or the YMCA. Organizations like these are opportunities for kids to spend time together with adult supervision, and usually offer programming focused on healthy youth development and empowerment.
3. Get help: If you suspect there is an issue, reach out to your child’s primary care provider for help. They will be able help facilitate you and your child in getting connected with therapists and other resources to further address the issue.

If you are concerned that your child may have disordered weight control behaviors, contact your child’s primary care provider today. One of our providers will be happy to assist you and your child in getting the help you need.