If you’re a teenager on social media, you are probably bombarded by explicit and subliminal messages that make you question your appearance and make you think twice about what you put in your body.
On TikTok for example, you’ll find an avalanche of videos from dieting and fitness influencers telling you what you should eat. But just a few swipes later, you might find a video saying the opposite of what the previous person said.
Good advice is available on social media platforms if you are able to parse through the mixed messages. But if you're a kid who is already dealing with insecurities and anxieties, it can intensify body image issues and harm your relationship with food.
More young people are seeking treatment at Children’s Mercy, says Sara Gould, who runs the hospital’s eating disorders center. That’s especially true since the pandemic. She’s even seeing more frequent visits from elementary school kids.
“Our kids are getting a lot of messages and following dieters or ‘nutrition experts’ and getting a lot of false information or information that’s solely intended to address obesity,” Gould says. “When you apply that in a typical weight person, it’s not healthy. But those kinds of messages are often presented as always the best thing to do.”
Nationally, visits for people younger than 17 seeking treatment for eating disorders jumped more than 107% from 2018 to mid-2022. That’s especially concerning because eating disorders have the second highest mortality rate of any mental illness, trailing only opioid misuse.
Visits for anorexia nervosa, which has the highest death rate of any eating disorder, jumped nearly 130% over the same period. Hospitalizations for eating disorders also spiked during the pandemic, doubling among teenage girls, according to the Centers for Disease Control and Prevention.
And, the rate of children under 12 being admitted to hospitals for eating disorders rose about 120% in less than a decade, reinforcing what Gould is seeing at Children’s Mercy.
Gould said genetics might play a role in some eating disorders, but a driving force is the pandemic bringing adolescents indoors and into a more digital world. During this time, the need to cope went up and the resources available to cope went down.
“We’re seeing a lot in our world judged by image — with likes, with comments, positive and negative,” Gould said. “Kids are much more tuned in than they were in the past to the power their appearance can have for seeking a place of belonging.”
Social media has also ushered in new body ideals among young men concerned with building muscle. In superhero movies, for example, muscular but lean titular heroes have been replaced by actors using steroids to reach peak bodybuilder physiques.
Nearly a quarter of boys and young men in the United States are engaging in some type of muscle-building activity. According to a doctor at Boston Children’s Hospital, about 60% of young boys in the U.S. mention changing their diet to get more muscle.
A study in Ontario found that rates of eating disorders among boys between 5 and 17 rose 416% from 2002 to 2019.
“It used to be if you asked 100 people what do you think is an eating disorder, they would say an emaciated, bony, white rich girl,” says Beth Harrell, a Kansas City dietitian and member of the Missouri Eating Disorder Council. However, she says, “restrictive eating disorders happen at all sizes, across all cultures.”
Of the four major eating disorders, anorexia, bulimia and binge eating are tied to body image. The fourth, Avoidant Restrictive Food Intake Disorder, is more phobia and sensory-based.
Harrell says almost half of restrictive eating disorders happen in people who have average to above-average-sized bodies.
“Many of our patients go to the doctor and they say you need to lose weight. That is bad for their body image,” says Kyle Sewer, director of EDCare, an eating disorder treatment center in Overland Park. “You see people in a larger body who are still medically healthy.”
Treatment gaps
While Kansas City has the Children’s Mercy Eating Disorders Center and other folks working to provide therapy or treatment for eating disorders, Harrell and others say there’s a need for new resources and awareness efforts if treatment is to keep up with the recent exponential growth.
Kansas City, Missouri, city council member Andrea Bough found that out the hard way after her daughter Ashley was diagnosed with anorexia nervosa when she was 13. Ashley had just come home from sleep-away camp and told her, out of the blue, that she had an eating disorder.
“We tried to be careful about how we talked about food,” Bough said. “It was just energy for our body.”
Ashley, who recently got married, is one of nearly 30 million Americans who will have an eating disorder in their lifetime. Bough often speaks on behalf of her family’s experience.
Bough and her daughter started working with Children’s Mercy and went to group therapy to help address the issue, but the changes to their lives went much further. She says they stopped talking about calories and stopped looking at scales. Her family went around the house taking labels off of everything and Bough started a spreadsheet to help manage her daughter’s eating disorder.
“We treated it as an illness because that's what it is,” she says. “It was a hard few years. Fortunately, I was in a position at that point that I could devote my time to her.”
Outside of Children’s Mercy, Bough found a local eating disorder group that was sending folks to schools to help spread awareness and educate teachers on how to approach these subjects with students.
But she said the chapter seems to have disbanded in the past few years. The last Facebook post for the group came in 2022. Without it, there are even fewer voices at the city level.
Because doctors were able to diagnose Ashley early, she didn't need inpatient care and did not exhibit many physical manifestations of the illness. But many aren’t as lucky or have as much time to devote to their loved one’s eating disorders.
Early warning signs an adolescent might have an eating disorder include changes in eating and activity habits, body image concerns, increased irritability or fluctuating moods, and changes in social behaviors.
A place of belonging
Treating eating disorders can often be a lifelong struggle.
That’s why in her capacity as an elected official, Bough partners with the Kansas City Health Department to organize an annual panel with local experts to increase awareness and activity.
But that’s only once a year during Eating Disorder Awareness Week, which is usually in late February. Bough hopes the health department will make these talks more frequent.
“The way that you approach and talk to someone suffering from an eating disorder is completely different than others,” Bough says. “It is truly talking about how to be healthy and how to find confidence in who you are.”
Harrell, of the Missouri Eating Disorder Council, says people like Bough are helping others take note of this crisis and fill some of the gaps in treatment.
In the past few years, the state council has run digital awareness campaigns, helped screen more than 15,000 Missourians for possible eating disorders, and trained more than 500 health care providers. Harrell says Swope Health is also adding staff focused specifically on people with eating disorders.
But training health providers won’t fix all of the gaps in Kansas City, especially as doctors see more cases among young people. Treating eating disorders in kids often requires longer sessions and more deliberate one-on-one attention than adults.
But Harrell hopes this work might bring more attention to this underemphasized part of the current mental health crisis among teens and maybe lead to more space where kids go to feel heard.
For eating disorder treatment, Harrell recommends first contacting a primary care physician who can make recommendations to a specialist.
“It comes to ‘Can I be accepted?’” Harrell said. “So, ‘Can I be accepted in the body that I have? Can I be accepted in the way that I eat?’”
