What You Don’t Know About Eating Disorders Could Kill Someone You Love

Do you have a daughter or granddaughter who loves sports? Make sure you support her in healthy ways so she can reap the benefits of sport without body-shaming. Which could lead to Female Athlete Triad or a full-blown eating disorder.

This month, in honor of National Mental Health Awareness Month, I’ll explore a variety of mental health issues—some more recognizable than others. One in five persons in the United States suffers from some sort of mental health problem, yet the stigma surrounding mental health remains. The more we know about mental health problems, the better we can come alongside those who suffer.

Diary of an Athlete with Female Athlete Triad

Every day, Meena (not her real name) exercised and ate only the healthiest of foods. She made sure only vegan, raw foods—the kinds of food with the best nutrients—entered her body. Above all, Meena wanted a slim athlete’s body with a six-pack for abs. Her coach told her could jump higher and run faster if she lost a few pounds.

And once she lost a few…

Every morning I would step on the scale and every morning the number went down. I wanted to lose weight, so it was a victory. Whenever people would tell me, “You’re too thin,” I would take it as a compliment. To me it was the same as if they had said, “You’re so beautiful!”

My hair started to fall out, my clothes got loose, and I felt tired and hungry all day. But I still wanted to be thinner. I remember one day my mom, obviously worried, finally asked me, “How much do you weigh?” I gave an evasive answer. She took me to the bathroom and had me step on the scale. I weighed 105 pounds. At 5’8” that meant my BMI was at 16 (anything below 18.5 is underweight). How could eating only healthy foods put me at risk?

Female Athlete Triad

When Meena’s worried parents took her to the pediatrician, the doctor ordered a bone density test. Everyone but the doctor seemed shocked when the results of the test showed Meena had the bones of a 90-year-old woman. The doctor diagnosed Meena with Female Athlete Triad and referred her to both a counselor and a nutritionist.

No one in Meena’s family, including Meena, had ever heard of Female Athlete Triad. They discovered Meena had the three classic indicators of the syndrome: irregular cycles (amenorrhea), bone loss (osteoporosis), and disordered eating.

Each interconnected element of Female Athlete Triad can bring harmful consequences. Disordered eating can cause amenorrhea, which triggers a response in the body similar to what happens in a postmenopausal woman.

Julie A. Hobart, M.D., and Douglas R. Smucker, M.D., M.P.H, in a paper written for American Family Physician say, “The consequences of lost bone mineral density can be devastating for the female athlete. Premature osteoporotic fractures can occur, and lost bone mineral density may never be regained.”

If untreated, female athletes will suffer mineral density loss and easily fracture their bones. It can happen suddenly and have lasting results. Eating healthy foods obsessively can actually cause more harm than good.

The Gateway to Eating Disorders

First identified in 1992, Female Athlete Triad doesn’t have a designation in the DSM-5 (the American Psychiatric Association’s official diagnostic manual for mental illnesses). But females who suffer from it often develop a full-blown eating disorder. You could call it a gateway illness to a more serious mental illness.

The second type of disordered eating plaguing athletes goes by the name of RED-S, which stands for Relative Energy Deficiency in Sports. Both boys and girls, as well as adults, can experience RED-S—a second gateway condition. According to the American Psychiatric Association, “Many athletes do not meet criteria for an eating disorder, but do engage in harmful eating practices, such as fasting or avoiding certain types of food.”

Both of these conditions include disordered eating which can lead to anorexia nervosa or bulimia nervosa. According to Hobart and Smucker, “Even though most women with the triad do not meet strict criteria for anorexia or bulimia, they still appear to have a greater risk of mortality than that of the general population.”

How Can You Help Prevent Eating Disorders and Disordered Eating?

We can’t prevent bad things from happening. But we can develop an awareness of disordered eating that leads to Female Athlete Triad and RED-S. We can work to accept people (including ourselves) in ways that help others have a healthy body image.

1. Start with Yourself

Sometimes the best way to help others involves helping ourselves first. Take an inventory of your feelings about weight and body image. If you don’t feel comfortable in your own skin and embrace yourself as you are, you won’t model a good body image for your daughters or granddaughters.

Spend time exploring your family history of weight, body image, and food. My grandma would make comments about people’s size all the time. Perhaps because she tipped the scales at under 100 and only stood 5-feet tall. “She’s so large,” Grandma would say, then hurry to add, “but she’s a nice person.” Too polite to use the term ‘fat,’ Grandma still had decided opinions on what one should look like.

Grandma’s comments and society at large played a huge role in how I saw myself. I’ve had an unhealthy relationship with food much of my life. I don’t eat a bag of chips by myself at midnight, though. My unhealthy relationship presents itself as a judgmental attitude towards the ways other people eat. I default to Grandma’s judgments about ‘people of a certain weight shouldn’t eat sweets.’

The unhealthy expectations I set for myself and others about food, quantity of food, quality of food, and what others should look like prevent me from portraying a healthy body image. Really, though, it’s none of my business. No one made me the cafeteria monitor for everyone in the world.

I’m learning to accept food at face value. It provides important nutrients and fuel for my body so I can do the things I love to do and stay healthy enough to enjoy time with family.

When you do your own body-image inventory, you may realize you want professional help to deal with past issues, traumas, or attitudes surrounding food and body image. Seek help if you need it.

2. Say Positive Things About Others

“Mommy, look at that fat lady!”

I’ll never forget how mortified I felt when my three-year-old daughter made this declaration in the line at the grocery store while pointing to the woman in front of us. Fortunately, she said it in Spanish. Her innocent words made me realize I had a problem.

I tend to criticize people rather than build others up. I’ve entered a life-long battle to control the unkind thoughts in my head and prevent them from leaking out my mouth. It’s not easy. But if I want to help the teens I work with have a positive body image, I need to model acceptance and kindness.

3. Avoid the Sexualization of Girls

Don’t ask your kindergartner if she has a boyfriend, and don’t buy a sexy-looking bikini for your four-year-old. Save her skin and buy her a cute surfing outfit instead. Little girls don’t need to look like teen models. Buy comfortable clothing that covers all the appropriate areas of her body in the colors she loves.

Teach your daughter about human sexuality—but don’t shame her if she wants to wear a pair of pants or shorts. Go clothes shopping with her and help her learn about the power of clothing and the message it gives. Clothing should boost our confidence, feel comfortable, and look good on us. It should make us happy.

Likewise, explain Victoria’s Secret. Sexy lingerie has a place (but your 14-year-old daughter doesn’t need to worry about it yet). When you see girls and young women sexualized on television or in pop culture, call it out. Do this if you have boys, too, they need to understand how to treat women with respect.

4. If You Have an Athletic Daughter

I love how girls can feel their power through athletics. Participating in sports provides countless opportunities for leadership, growth, and self-confidence. Guard those positives and keep a wary eye out for the negatives.

Make sure your daughter participates in sports because SHE wants to, not because you want to live vicariously through her. Before she starts a sport, make sure she understands you love her because of who she is, not because of how she plays or performs.

Remember to praise the product and encourage the child. If she plays great defense, tell her, “I see how your hard work at conditioning has paid off in the way you protected the goal during the game. Keep up the good work!”

Listen for body-shaming from teammates or coaches. If you hear it, initiate a conversation with the person who spoke it. Let them know how you feel about the importance of healthy body image for all athletes.

If you have an athletic daughter who suddenly exhibits changes in weight, and signs of disordered eating, take note. Arrange a visit with a pediatrician and express your concerns. Early intervention is imperative.

5. Understand the ACEs

ACE stands for Adverse Childhood Experiences, and you can learn more about it here. The higher a child’s ACE score, the more likely the child will suffer from mental illnesses (including eating disorders) later on in life.

Teach your children resilience and grit. This great article from the American Psychological Association explains how to build resilience. Avoid the temptation to act like a helicopter or lawnmower mom. Teach your kids how to problem-solve and think critically.

6. Make Sure She Understands Her Identity in Christ

Christian girls don’t have a free pass from self-doubt, anxiety, eating disorders, or mental illness. Make sure you raise your daughters to know their identity in Christ. Every girl is a beloved princess, the daughter of the the King. It doesn’t matter what the world thinks.

See what great love the Father has lavished on us, that we should be called children of God! And that is what we are! The reason the world does not know us is that it did not know him.

1 John 3:1 The Message

Want to Raise Healthy, Happy Daughters?

I write from the experience of a mom who didn’t do everything right. A lot of my list comes from hindsight. Oh, Dr. Google, where were you when my girls were young? If you want to prevent your daughter from suffering from things like Female Athlete Triad, RED-S, anorexia nervosa, bulimia nervosa, and binge-eating disorder, take action now.

Check out the resources section for ways you can equip yourself to understand more about eating disorders.

Resources for Parents and Teens

Check out this review of Furia by Yamile Saied Méndez. This beautiful own-voices novel shows the power of a young woman who knows what she loves (soccer) and who pursues it despite the obstacles.

Chasing Silhouettes: How to help a loved one battling an eating disorder, by Emily T. Wierenga, shares the author’s story of growing up in a Christian home. And struggling with an eating disorder.

Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating, and Positive Body Image at Home by Marcia Herrin.

The Girls at 17 Swann Street: A Novel by Yara Zgheib is one of the most poignant novels about anorexia nervosa I’ve ever read. This is a book I wish I would have read before my daughter turned 13. With the sensitive strokes of one who has lived through anorexia, the author paints another layer onto my portrait of understanding this often-misunderstood disease.

This is a must-read book for those who have a family member that struggles with an eating disorder or anyone who has a family member with a high ACE (Adverse Childhood Experience) score. Knowledge is power—and learning about the psychology behind anorexic thinking through the eyes of one who suffers helps us understand our role in helping someone recover.

Letting Ana Go by Anonymous shares the diary of a teen girl who seeks to control something in her life by controlling her food intake.

The book will leave you outraged at the insurance systems’ treatment of mental illnesses.

Listen to the Self-Care Hacks podcast this month for more information on mental illnesses and how you can help.

If YOU Have a Story

If you have a story relating to mental health or mental illness, please hop over to this special, month-long link-up where we can share our stories and help stop the stigma surrounding mental illnesses.

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