Lady looking at herself in mirror

Dawid Markiewicz

Getting kids to eat their veggies is a generations- old battle in many households. Yet what is only a parental nuisance for most can become a much more serious problem for some. “Being a picky eater is a risk factor for developing an eating disorder, but we don’t consider it a true eating disorder unless it has affected a child’s wellbeing,” says Dr. Kimberli McCallum, CEO, medical director and founder of McCallum Place, an eating disorder treatment center for adolescents and adults.

Both physical and emotional wellness are at issue. Proper physical development is one concern. In addition, extremely picky eating may be a sign of a primary anxiety disorder, says Dr. Laura Huff, director of the eating disorders program at St. Louis Behavioral Medicine Institute. Eating disorders also may be related to emotional trauma, food allergies or medical conditions, such as irritable bowel syndrome.

McCallum notes that children can “inadvertently lose a lot of weight, and if they’re genetically vulneravulnerable to develop an eating disorder, once their weight gets below a certain point they develop what I call ‘hungry brain.’ ” This is McCallum’s child-friendly term for an obsessive focus on diet and body size. Kids with ‘hungry brain’ tend to become “very selfcritical, very anxious, and prone to developing more ritualized eating.”

Less than 1 percent of children under the age of 12 have a diagnosable eating disorder. “Usual age of onset of eating disorders is during adolescence. Unfortunately, we are seeing more and more younger children, under age 12, who are developing anorexia nervosa or bulimia nervosa, or some variation on those disorders,” says Dr. RandallFlanery, adjunct associate professor of family medicine at Saint Louis University and director at Webster Wellness Professionals.“With younger children, the eating problems can look a lot like obsessive compulsive disorder with rigid patterns of behavior, distorted beliefs and tremendous anxiety, if the child does not eat right.”

Flanery notes that if a parent is concerned, especially if a child appears to be losing weight or is not growing, it’s a good idea to talk with the child’s physician to make sure any underlying medical issues are identified and addressed. A referral to a mental health provider may be the next step in treating disordered eating, and evidence indicates that early intervention involving the entire family is often the most successful approach.

“The most likely indications of an eating problem are the youth making very negative, critical comments about themselves regarding eating, weight or shape—I’m talking about extremely judgmental statements about their own self-worth based on these physical characteristics,” Flanery says. “The negative judgments can be present before really harmful weight control practices might begin.”

Parents should model healthy eating, offer a variety of foods, strive for family-centered mealtimes, and remind children that value as a person isn’t dependent on appearance. Flanery reminds us that “appreciating each other for the whole person, not just appearance, is excellent prevention for eating disorders and important for all of us to remember.”