Talking to your adolescent about body image can be a sensitive subject for any parent. This topic is even more complex for the parent of an adolescent with an eating disorder. The parents in Walden’s Adolescent Intensive Outpatient Program say that when their child brings up the topic, it is often in the context of feeling fat or hating their body. When the child is not talking about their body, parents say they’re nervous to raise the subject for fear of saying something that will be triggering to their child.
In group, I have asked adolescents what might be helpful to hear from your parents around body image. Most kids say, “Nothing, I don’t want them to bring it up at all.” Unfortunately, that is unrealistic since parents are a large part of treatment here, and they need to know how to respond appropriately to negative body image statements. Parents are also the ones who are with the adolescent the most, particularly during snack and meal times, when the kids struggle the most.
When we talk about body image in our cognitive behavioral therapy (CBT) group, body image is referred to as the relationship you have with yourself and how you view your body. Not to our surprise, almost all of our clients say they have a negative relationship with their body. In order to change that relationship, the adolescent must be healthy enough to work on challenging the way they see their body. On the road to recovery, a healthy relationship with their body is usually the piece of recovery that takes the longest. Even after a child has reached their ideal body weight, they must continue to work towards developing and maintaining a healthy body image.
It is important to validate how hard gaining weight is and that your child might feel uncomfortable throughout this process. The gaining weight piece is uncomfortable; no one really enjoys gaining weight. It is important to remind the adolescent that the gaining process is only temporary until they have reached their healthy weight. Once a child is at their ideal body weight, they can begin to accept their new body and learn to feel comfortable in it again. When talking about gaining weight, the focus shouldn’t be entirely on appearance; the focus can start to shift to what the adolescent is allowed to do again. When adolescents have goals they are working towards that are associated with weight gain, it tends to make their changing body tolerable. Returning to sports they once enjoyed, participating in yoga, or getting to go out with friends are all rewards that our adolescents have identified as things that have helped them in recovery. Returning to sports and physical activity is a large piece, as they are able to focus on what their body is capable of doing again.
There are times when they may feel bloated or uncomfortable after eating a larger meal than their body is used to, and that is normal; but there are often times when there are external factors that play a role in a bad body image day. In CBT we talk about how no one wakes up one day in a perfectly good mood and suddenly feels fat, there is always an underlying emotion as to why they feel that way. For some kids it could be a hard day at school with friends, feeling behind in classes after missing days, or conflict with siblings. It has become easier at this point to blame their body and say they feel fat, rather than express or articulate other uncomfortable emotions. Therefore, when your adolescent comes to you saying they “feel fat,” instead of immediately challenging their distortions, you can begin with validating how they feel about their body. Ask them how their day went and try discovering what event triggered the negative body image thoughts.
About the author:
Michelle Felton is the lead clinician of the Adolescent Intensive Outpatient Program for Walden Behavioral Care in Waltham, MA. She earned her bachelor’s degree in Psychology from Keene State College and her master’s degree in Community Mental Health from Argosy University in Phoenix, AZ. Michelle’s professional interest include the treatment of eating disorders in adolescents, athletes, and families.