Obesity in teens is a big problem but so is disordered eating. Several years ago, it seemed like every media outlet was shouting from the rooftops about the childhood obesity epidemic. Back then, I wondered how the obesity panic was going to affect kids and teens. Scaring and shaming kids into weight loss (I’d like to say healthy habits, but shedding pounds appears to be the main focus) can bring other unhealthy consequences.

According to recent research in November’s International Journal of Eating Disorders, disordered eating, such as  not eating enough, skipping meals, fasting and using food substitutes, was actually common among a sample of 412 overweight teens (see here for abstract). The teens completed self-report questionnaires in 1998-1999 and again five years later. This research is part of a big longitudinal study from the University of Minnesota called Project EAT.

Study Results

(Time 1 refers to EAT I; and Time 2 is EAT II):

Among girls:

  • Among the 232 overweight female adolescents, 30.8 percent engaged in disordered eating at Time 1; at Time 2, it increased to 40.1 percent.
  • Of girls who didn’t engage in disordered eating initially, about one-third of them started to by Time 2.
  • Among the 71 girls who were already engaging in disordered eating at Time 1, about half continued engaging in disordered eating at Time 2.

Among boys:

  • Among the 180 overweight male adolescents, 13.4 percent engaged in disordered eating at Time 1; at Time 2, 20.2 percent  did.
  • Among the 24 overweight males engaging in disordered eating behaviors at Time 1, 37.6 percent continued at Time 2.
  • Of the boys who didn’t engage in disordered eating, 17.5 percent started by Time 2.

Disordered eating behaviors can also serve as a gateway to more extreme methods of weight control, such as self-induced vomiting, diet pills, laxatives and diuretics. In fact, almost all the girls who reported disordered eating at Time 2 used at least one extreme method and a third reported binge eating, with loss of control. Same with the boys: The majority who engaged in disordered eating also used extreme methods and almost a third reported binge eating.

Also, the study found that weight importance and reading magazines with articles on dieting and weight loss served as risk factors for disordered eating. Depressive symptoms increased risk in boys.

Factors that protected against disordered eating were family connectedness, body satisfaction and eating meals regularly. Higher self-esteem was also protective for girls.

More Project EAT Findings

Below, I’ve also excerpted the findings from all teens in Project EAT. These findings are based on a sample of 4,700 teens in EAT I and over 2,500 of the same teens in EAT II :


  • Forty percent of students went on a diet in the past year.
  • Eighty-five percent of female and 70 percent of male students used moderate dieting behaviors such as eating less high-fat food, eating less sweets, and eating more fruits and vegetables over the past year.
  • A concerning 56 percent of females and 32 percent of males used unhealthy dieting behaviors such as skipping meals, using diet pills, and smoking more cigarettes, specifically to lose or control their weight.
  • A smaller but quite worrisome percentage of students were the 12 percent of females and 4 percent of males who reported use of dangerous dieting behaviors such as taking laxatives or diuretics, vomiting after meals, or fasting.
  • Approximately 3.5 percent of students surveyed reported having a doctor tell them they have an eating disorder. Undoubtedly, the high rates of overweight and obesity among youth is a major public health concern, but disordered eating and eating disorders are also of great concern.


  • Among females who transitioned from middle school to high school the percent reporting unhealthy behaviors (e.g., skipping meals) increased from 49 percent to 59 percent and the percent using extreme weight control behaviors (e.g., taking diet pills) increased from 9 percent to 18 percent. Extreme weight control behaviors also increased from 14 percent to 24 percent among females who transitioned from high school to post-high school.
  • The use of unhealthy weight control behaviors decreased among males who transitioned from middle school to high school. However, among males who transitioned from high school to post-high school, the percent using extreme weight control behaviors doubled (from 3 percent to 6 percent).
  • Students using unhealthy dieting behaviors at Project EAT-I were at increased risk for binge eating and using dangerous dieting behaviors at Project EAT-II.
  • Students using unhealthy weight control behaviors at Project EAT-I were three times as likely to be overweight at Project EAT-II as teens who didn’t use unhealthy weight control behaviors.

These findings can make any parent fearful and confused. How do you promote a healthy lifestyle to your kids? If your child is overweight, how do you help them without sending them into disordered eating territory?

For the answer, I emailed with Dianne Neumark Sztainer, Ph.D, M.P.H., R.D., the lead researcher of the study and principal investigator of Project EAT.

1. The country is fixated on childhood obesity, however, your newest study  found that disordered eating is also a persistent problem among overweight teens. Fortunately, your study found that body satisfaction and family connectedness were protective against disordered eating. Many parents are at a loss about how to help their kids – with the obesity scare on one hand and disordered eating on the other. How can parents help their overweight teens without fostering unhealthy habits to lose weight? What can teens do?

I’m actually going to refer you to my book, I’m, like, so fat! Helping your teen make healthy choices about eating and exercise in a weight-obsessed world. I wrote this book for parents who are struggling with exactly the issues that you raise here. I wanted to provide parents with research-based recommendations for helping their children feel good about their bodies and have a healthy weight. My main advice for parents is to “Talk less. Do More.” Talk less about weight and do more to make your home one in which it is easy to make healthy eating and physical activity choices. I’m attaching a copy of the 4 cornerstones and the research explanation for each, which I include in my book [see below for the excellent chart].

2. I write a lot about the dangerous messages women’s magazines convey to women and teens. What are your thoughts on teens reading magazines and their effect on disordered eating?

The media definitely has an impact on teens’ weight-related attitudes and behaviors. Encourage the reading of magazines such as New Moon, which is written by girls for girls and focuses on the development of total character.

3. Anything else you’d like readers to know about disordered eating among

These are harmful behaviors and should be taken seriously!

The 4 Cornerstones: What can families do to help their teens achieve a healthy weight and positive body image?*

1. Cornerstone behavior: Model healthy behaviors for your children.

Specific steps that parents/families can take

  • Avoid dieting or, at least, unhealthy dieting behaviors.
  • Avoid making weight-related comments as much as possible.
  • Engage in regular physical activity that you enjoy.
  • Model healthy (but not perfect) eating patterns and food choices.

Supportive research

  • Although not consistent across studies, correlations are often seen between parental and adolescent eating, activity, and dieting behaviors. Associations are strongest when behaviors are noticed by teens (i.e., reported by teens rather than by parents).
  • Parents’ comments about weight may be more important than their behaviors. In the AHEAD study, negative weight comments within families were one of the strongest correlates of unhealthy weight control practices in teens with type 1 diabetes.

2. Cornerstone behavior: Provide an environment that makes it easy for your children to make healthy choices.

Specific steps that parents/families can take

  • Make healthy foods readily available.
  • Establish family meal norms that work for your family.
  • Make physical activity the norm in your family, and limit TV watching.
  • Support your teen’s efforts to get involved in physical activity.

Supportive research

  • In Project EAT, the strongest correlate of fruit/vegetable intake was home availability.
  • In focus groups, the teens stated very clearly:  “If it’s out, I’ll eat it!”
  • Family meals are strongly correlated with better dietary quality.
  • Research suggests the importance of decreasing sedentary activity and increasing physical activity for weight management and the important role that parents can play in supporting their children’s efforts to be active.

3. Cornerstone behavior: Focus less on weight; instead, focus on behaviors and overall health.

Specific steps that parents/families can take

  • Encourage your teen to adopt healthy behaviors without focusing on weight loss.
  • Help your teen develop an identity that goes beyond physical appearance.
  • Establish a no-tolerance policy for weight teasing in your home.

Supportive research

  • Dieting for weight loss is associated with weight gain over time and the onset of disordered eating/eating disorders, suggesting the importance of focusing on more effective behaviors that can be implemented safely over a long period of time.
  • Among teens, body image and more global self-esteem tend to be linked and there is a high prevalence of body dissatisfaction among teens.

4. Cornerstone behavior: Provide a supportive environment with lots of talking and even more listening.

Specific steps that parents/families can take

  • Be there to listen and provide support when your teen discusses weight concerns.
  • When your teen talks about fat, find out what’s really going on.
  • Keep the communication lines open – no matter what.
  • Provide unconditional love, not love based on weight, and let your child know how you feel.

Supportive research

  • The prevalence of weight-teasing is high among teens, particularly overweight teens.
  • The impact of teasing on psychological well being and disordered eating was found to be high in Project EAT.
  • High levels of family communication protect adolescents against an array of health-compromising behaviors.
  • In individual interviews, overweight teens indicated that in the face of weight-related teasing/mistreatment, they appreciated support from their family, not weight-loss advice .

*Source: Neumark-Sztainer D. “I’m, Like, SO Fat!” Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World.” New York: The Guilford Press; 2005.

What do you think about this research? How do you help your teen build healthy habits and avoid disordered eating?