Why kids are vulnerable
Eating disorders have been documented across cultures for hundreds of years and are linked to certain personality traits that appear to be inherited—such as high levels of anxiety, perfectionism, obsessive-compulsive tendencies, depression and addiction.
"With genetics, kids can be preloaded," says Kelley. So when a kid with a genetic predisposition for obsessive-compulsive disorder (OCD) goes on a diet, for example, the combination of calorie restriction and obsessive-compulsive behavior can quickly create an eating disorder.
It's impossible to predict exactly which of the many children who show signs of disordered eating will go on to develop an actual eating disorder, but there's no doubt that the world we live in isn't exactly helping to protect them.
For one thing, kids today hear a lot more about weight and body shape than we heard in childhood. They get anti-obesity messages at school (which can sometimes backfire, making perfectly healthy children paranoid about ice cream and other "fattening" foods), are bombarded by weight-loss ads on TV, see six-pack abs on the covers of magazines and idolize stars in teeny-tiny jeans.
Our culture serves up such a vast smorgasbord of body judgments, is it any wonder that so many kids are unhappy with the way they look?
"Children today are internalizing the idea of not being okay with who they are, and dieting is a way to change that," says Dena L. Cabrera, a psychologist at the Remuda Programs for Eating and Anxiety Disorders.
Kids also participate in sports at a much more competitive level than they did in the past. Some activities—like gymnastics, ballet, wrestling, running and diving—can make them particularly conscious of their appearance, because their bodies are under heavy audience scrutiny and weight can affect the outcome of the competition.
"One of my patients developed an eating disorder at age thirteen when her figure-skating coach told her that she would look much better in her outfit if her rear end were smaller," says Natenshon.
For girls, puberty itself can be a trigger in this era of stick-thin stars. Kids tend to grow taller in rapid growth spurts, but they gain weight a bit at a time, all along the way.
Right before a growth spurt, both girls and boys can look a little chunky because their height hasn't caught up yet with their additional weight. For girls approaching puberty, add breast buds and widening hips, and you've got a recipe for self-consciousness. They may begin to diet or exercise excessively as a way to compensate.
Nowhere near all kids who exhibit early symptoms of an eating disorder will go on to develop the full-blown disease. But parents need to recognize the warning signs because it's far easier to prevent a case of disordered eating from becoming an eating disorder than it is to treat an entrenched case.