How Do I Support a Teen Who Hates Her Body?

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Reena Ninan:

I loved the marshmallow puff guy from Ghostbusters in the eighties, but I feel like I am turning into the marshmallow puff guy because of whatever perimenopause. Everything in my life I attribute to perimenopause. I don’t understand. You’re the right age. I’m the right age 45, right? Yep. Even though I don’t want to admit it,

Dr. Lisa Damour:

I know,

Reena Ninan:

But what is up with this? I just suddenly feel

Dr. Lisa Damour:

Like I’m glimping up here. The body changes and metabolism changes. And one thing Reina I think is so interesting is how now mainstream it is for there to be good information and books and articles. And my theory is that now the editors of all of the news outlets are themselves perimenopausal and menopausal women. And so now we’re getting good information for the first I think

Reena Ninan:

Generation ever. You’re totally right. And also there just has not been the level of research that there should have been years ago. So what we’re learning, and thank you all for joining us on this journey because you’re going to be hearing about it because it is not an easy one, but let us to think about weight a little bit, right? And we’ve gotten so many letters over the years about this, and so we wanted to talk to you a little bit about how do you support a teen who might not like their body, and I can understand personally at 45 as well. I want to read you this letter. Dear Dr. Damour, I’m writing to ask you if you would be able to address on your podcast what I find to be the thorniest issue in parenting to teenage girls and where I can’t seem to find clear but reasonable advice.

Both of my daughters ages 15 and 17 expressed tremendous dissatisfaction and sadness about their bodies. They’ve both gained maybe 10 to 20 pounds in the past couple of years and they are unhappy with being overweight. This manifests in their clothing choices, how they talk about themselves to others and how they talk to themselves. One of my daughters is a dancer and the others a soccer player. So they are engaged in organized physical activity, but they do not choose to exercise outside of scheduled classes or practices. Healthy food choices are provided home, but we don’t police their eating habits and there is also easy access to junk food with friends for purchase at school, et cetera. Our pediatrician suggested not discussing weight due to the high risk of eating disorders, and of course I believe they are beautiful inside and out regardless. Yet at the same time, speaking in terms of body positivity just feels like it echoes so hollow because they are unhappy with their sizes. I do not know how to thread the needle in wanting to support them to make healthier changes that would make them feel happier about themselves versus just keeping silent so as not to cause lasting emotional damage. Any words of wisdom, it would be so appreciated. Thank you. Oh gosh, I can just sense everything in this letter, right? It has everything. It has everything. Yeah. I want to ask you first off, I love that they’re active. It’s not like they’re couch potatoes. What do you make of this kind of weight

Dr. Lisa Damour:

Gain? So one thing that’s important to know is that teenagers gain weight through puberty and girls gain weight through puberty, that it’s typical and expectable for there to be a decent amount of weight gain over the course of puberty. They gain strength, they gain muscle, they add body fat, and so at least some of that. And then the question is how much of that weight gain is exactly what we would expect to see. And another way to put it is that if a teenager’s weight goes flat over the course of adolescence, something’s wrong. If they aren’t gaining weight as they move through high school

Reena Ninan:

For boys and girls,

Dr. Lisa Damour:

For boys and girls, boys, we should talk about boys, right? Their body image stuff has become way more complex than it used to be, but for both boys and girls, we do expect to see them gaining weight as they grow and age through high school. So some of this is absolutely to be expected. We do not expect teenagers to stay at the same weight from 13 to 17, 18. That’s very strange and worrisome on its own.

Reena Ninan:

It makes sense now that I think about it because getting taller, you’re growing. You should be gaining weight. Okay, I love what this mom says. She’s worried about sort of lasting harm lasting. She calls in this cause of lasting emotional damage. Is it true that discussing weight can lead to eating disorders?

Dr. Lisa Damour:

Yes. The short answer is yes. And I can tell you stories of kids I’ve cared for where they can point to the comment that really got them rolling. When thinking about a kid I cared for whose coach I think was well-meaning gave her a book that had all the calories of food. I mean this was a long time ago. I really hope nobody would do this now, but sort of like here, you should know this information. I think he was hoping she’d lose a little weight and then it was off to the races and really bad. I have heard of a dance teacher who told her students to eat more that did not help with kids who were already struggling with how they felt about their bodies. The fact of the matter is though the arrival of an eating disorder is a result of several factors coming together simultaneously, that it’s both what’s happening in the immediate stressors. There can be a comment from somebody, there’s a genetic or a biological factor that underlies it. Most of the time there can be immediate stressors. So we never say that eating disorders are the result of one thing and one thing only. But they are so dangerous, Rita, they are so dangerous.

Prior to the arrival of the fentanyl crisis, they were the most lethal psychiatric disorder. The chances of dying from anorexia are one in 10 bulimia hangs out around one in 25. I mean, you do not mess with these. You do not trifle with these. And so I see where the pediatrician is coming from of being like, don’t say anything because once you have cared for a kid who is dangerously eating disordered, it is so scary clinically that you want no family and no kid to even risk the possibility of finding themselves in that neighborhood.

Reena Ninan:

But what do I do as a parent? I want to teach them good eating habits. We were in target and they were free dumb dumbs for a signup. And I was like, no, no, no, you don’t need that sugar. And then I walked away thinking, was that the right thing I should have done? My daughter didn’t eat that sugar, but she just wanted a dumdum. So what do you advise us as parents when we have the kids at home or even if they’re back from college, what do we say even early on in the elementary years? What’s the right thing to say to build good relationships with food

Dr. Lisa Damour:

Is this is the billion dollar question, right? Because it’s so hard. And Rena, the way we started, the adults don’t come to this neutrally. We’re all carrying all of this baggage around our own bodies and our own appearance. Then of course, and I think a lot of us have this experience as parents, you then are watching your kid’s body grow and change and you have your own feelings about that. So there’s this huge murky cloud of emotions that come up around the dumb dumb at target where there’s a lot happening. So we have to push aside all of that fog to try to say something that we don’t regret. I’ll give a few framing ways to approach this, but then keep asking because it’s all in the details of the day. So the best stance, the best opening stance on eating weight and exercise is that we are all responsible for taking good care of our bodies.

So you start from there, and that means in terms of what we eat and how active we are, and if you use that framing of it’s our job to take good care of ourselves, then if your kid is eating nothing, but you can say you’re not taking good care of your body. If your kid is eating nothing but celery, you can say you’re not taking good care of your body. If your kid is never getting off the couch, you’re not taking good care of your body. If your kid is punishingly taking eight and nine mile runs every day, even with stress while injured, they are not taking good care of their body. So that helps to sort of manage the extremes. That stance of your job is to take good care of your body and my job is to help you do it and you’ve had nothing but hos. It’s 3:00 PM you’ve eaten nothing but a ho all day. You’re not taking good care of your

Reena Ninan:

Body. But tell me, I have girlfriends whose mothers did not allow them have any sugar. They were really ahead of the game as far as versus we had sugary cereals just every morning for breakfast practically growing up. Does telling your kids okay, you can’t have sugar, you reached your limit. What does that do? Is that the right thing to do?

Dr. Lisa Damour:

I’m not a fan really. I’m not a, I mean because sugar’s part of what makes life worth living. Rita, tell me about it. And that there is room in a healthy, balanced diet for treats. And I think if you take a no treats, no sugar stance, first of all, anyone in the eating disordered world would be like you’re already on the road to an eating disorder. As soon as you are dropping food categories without a doctor telling you you must drop a food category, you’re on that road. And Rena, not everybody who gets on that road goes all the way down that road. Everybody who goes all the way down that road starts by dropping food categories. But

Reena Ninan:

Our intention, Lisa’s parents are to, you don’t want to be eating all the sugar all the time. And trust me, my children love sugar. I told you we went to Sicily and they have this granita in a brioche run for breakfast. Everything was sugary. But what we decided was you start off with eggs or some protein and then you go back to the breakfast bar and get whatever you want.

Dr. Lisa Damour:

Absolutely. And I think my favorite always comes from Sesame Street. They’re with the sometimes foods in the Anytime foods, right? That’s brilliant. Okay, so the biggest framing is our job is to take care of our bodies.

Speaker 3:

Yes,

Dr. Lisa Damour:

You can then bring it in a notch and say, okay, so there’s sometimes foods and anytime foods, there’s foods that are anytime which are basically whole foods, proteins, grains, all of the stuff that isn’t processed is essentially I think a very good way to describe anytime foods. It hasn’t gone through a factory. It has fewer than five ingredients. And then there’s sometimes foods which is the other stuff.

So that way of talking about it I think is pretty rational and can keep things in balance.

Reena Ninan:

I want to pause and take a quick break on the other side. I want to ask you about boys and body image, something that kind of gets overlooked. And I also want to talk to you about positive body image. Does it really resonate with teens? What really works We’ll be right back. You’re listening to Ask Lisa, the Psychology of Parenting. Welcome back to Ask Lisa, the psychology of parenting. We got this incredible letter from a parent worried about her teen who hates her body. Lisa, I know we’ve been talking about girls, but I want to ask you also about boys. Do they struggle with the same kinds of body images as girls? What does the research

Dr. Lisa Damour:

Tell us? So we’ve done a pretty lousy job of researching body image in boys. We’ve tended to think about it as a girl issue, but we are seeing recently much more concerning behavior about boys, and I will just full on blame social media for this. A lot of looking at images are very muscular, very cut as they will talk about boys and men online. We actually did an episode about this last season because it’s so important. And so we are suddenly seeing boys who are engaging in what we would say is sort of classically eating disordered behavior with a slight twist. So usually the eating disorders, we’ve talked about them in ways that girls present where they are restricting a lot, losing a lot of weight in anorexia or engaging in what we call compensatory behaviors in bulimia where they try to get rid of calories they’ve consumed.

What we’re seeing with boys is this preoccupation with gaining muscle and losing fat and using all sorts of things that are not unlike what we’ve always recognized, being very restrictive about when they’ll eat or where they’ll eat or what they’ll eat, feeling bad about themselves if they don’t like how they look in the mirror, having that ruin a whole day. And one thing that’s very scary is that boys are coming to the hospital later than girls with eating disorders because they’re not so small. When girls are anorexic, you can hardly miss it. But when a boy has bulked himself up with muscle but deprived himself nutritionally, they don’t look excruciatingly thin. And we have some data showing they’re actually showing up at the hospital in worse metabolic shape, actually sicker than girls as a group because of this. So all of this has much more relevance to boys than it used to, which of course is horrible. Eating disorders are just, I get this pediatrician. I mean, I really see it.

Reena Ninan:

Yeah. What are the red flags for parents of boys? I know boys are obsessed with having a boy myself with a six pack, and should you be concerned if they’re trying to get certain amount of weights done every day or steps or what are the red flags to you?

Dr. Lisa Damour:

So it’s interesting. I would say for kids of all genders, there’s what they say and there’s what they do. And I actually am much more interested in what they do than what they say. So a kid might say like, I’m going to cut back on, I’m going to drop sugar or I’m going to cut back on sweets. But if a really good cupcake shows up and they’re like, tomorrow, I’ll cut back tomorrow, I wouldn’t sweat it too much. It’s the kid who the really good cupcake shows up and they’re like, no, no thank you. I’ve cut out sweets. Or the boy who’s like, I’m going to gain muscle. And then his friend’s like, Hey, do you want to go to the pool? And he’s like, no, I’m going to the gym. This is my leg day. I’m not missing my leg day. Isn’t that a good thing? He’s committing, committing to working out, right? No, you’re cringing. They’re committed versus rigid.

Reena Ninan:

Committed versus rigid.

Dr. Lisa Damour:

And it’s okay for kids to lift weights. I mean, we have ways that kids can do this safely and a lot of athletes do it. It’s when it starts to come at the cost of other things that matter in a kid’s life. So socializing with their friends or eating meals with their family. Kids will stop eating meals with their family because the family isn’t eating with the kid has decided for themselves as the right meal. And that’s true across all genders and all kinds of eating disorders. It feels obsessive. It feels like what’s driving the train is appearance and weight and fitness concerns not living a healthy, enjoyable life.

Reena Ninan:

But I’m confused because the teenage vanity years is all about appearance and how you look and what lip gloss you have on, but when does it get to a point that you really are seeing red flags and you’re on the road to an eating disorder

Dr. Lisa Damour:

When you feel like you’re negotiating with the eating disorder to the kid live their life or have the family live their life?

Reena Ninan:

So when it starts to affect your daily life, you

Dr. Lisa Damour:

Feel when you’re feeling like you’re coming up against it a lot is what I would say. I wouldn’t even wait so long as like, okay, now we can’t go to our favorite restaurant. I mean, that may be your first encounter of it, but the bottom line is if you have any anxiety that your kid’s thinking has sort of taken a turn where the eating disorder is calling the shots, that’s how we think about it. The eating disorder is deciding where that kid’s time goes, where that kid eats, what that kid’s doing. You get your kid to a pediatrician yesterday,

Reena Ninan:

Wow, okay.

Dr. Lisa Damour:

You don’t need to feel a hundred percent sure that you know what you’re seeing or that this is happening. You get this evaluated as soon as you become anxious about it. Right? I mean that’s don’t wait. Don’t wait. So don’t wait for three red flags. If you’re just like, this feels wrong, this doesn’t feel right. And Rena, part of how we want to think about it is that when people aren’t getting enough nutrition, their thinking starts to collapse. If you didn’t eat for 24 hours, totally, you can’t focus.

Reena Ninan:

Yeah, you’re right.

Dr. Lisa Damour:

And so they become like this tunnel vision around the eating disorder in part because they are cognitively compromised by the eating disorder. And so you don’t wait and you

Reena Ninan:

Don’t negotiate with us. Don’t wait, don’t negotiate. I’m looking at this letter, I’m trying to find the point in here where, yeah, here it is. It says they have both gained maybe 10 to 20 pounds in the past couple of years and they are unhappy with being overweight.

Dr. Lisa Damour:

Okay, so now this is interesting because now we have a question of overweight and like I said, some weight gain is health in adolescence, but this letter writer who is so acutely perceptive and very thoughtful is also saying they may be overweight. Okay. So then there’s that question of like, well, what if your kid is overweight? Can you say something? Can you do something? And there’s something else in this letter that I think gives an opening, which is it sounds like these girls are complaining about their bodies. These girls are expressing dissatisfaction. So what I would say is if you are a parent or caregiver with a kid who’s expressing dissatisfaction and you have your own concerns that they are in fact overweight, I think a safe way to enter this is to say, I hear what you’re saying about not feeling comfortable with your weight. Do you want to meet with your pediatrician or a nutritionist to talk about an approach to eating that might get you to where you want to be?

Reena Ninan:

And do you find that offering that option helps like they’re on board and they’re willing to do it,

Dr. Lisa Damour:

They probably need to think about it. What I can tell you is it’s a heck of a lot better than the parent saying, do you want me to help you change how you eat? Do you want to come up with a diet you don’t want to engage? You want to try to be as neutral in this as possible. As a parent, you are on the side of what the kid is saying, you are on the side of health and engaging third parties who are healthcare providers who can help this kid do it in a healthy way that keeps you out of it if you’re going to do it. That is my guidance about how to do it because then you have pediatricians and nutritionists who know what they’re doing, who know what they’re looking at, who can be a neutral party in this, who can ideally keep it from going too far because they know what to look for. So that would be my guidance. I think there’s also a tricky question here about what if your kid is overweight and saying nothing? And I’ve seen those situations where a girl is rapidly gaining weight, reasonable questions are arriving about her health and she’s just wearing sweatpants, not asking for new clothes and pretending like it’s not happening. That’s a really tricky thing. And I think even there, it’s probably a time to say, I love you. Your weight is getting to a place where I have questions about your health. Let’s talk to your pediatrician.

Reena Ninan:

I want to ask you about body positivity. Do you feel like that resonates with teens or does it kind of echo

Dr. Lisa Damour:

Hollow? I think this letter writer is dead on. I think that, I wish it weren’t this way, but I think that when adults stand in front of teenagers and say all the right things, you can be healthy at many sizes and all bodies are beautiful, and your job is to feel good about your body, not to be measuring it against these unrealistic ideals. I mean, these are all the right things to say. In my experience. Teenagers are like, yeah, right. Show me. 99.9% of the images in traditional media are featuring one kind of body. Everything I’m seeing on social media is featuring one kind of body. And you ladies, you adult ladies, we’re watching you all carry a whole bunch of baggage about your bodies. I mean, Reno, we’re in Ozempic years.

Reena Ninan:

Yeah, what a great point.

Dr. Lisa Damour:

And teenagers are well aware of it. And I mean, I recently had a colleague who ended up with a kid in her practice who was using her mother’s ozempic to become eating disordered. And so I think the beauty of teenagers is you can’t pull the wool over their eyes. You can’t say one thing when they’re watching the whole world tell a different story.

Reena Ninan:

What about when we were growing up and whatever issues with food or our relationship with food that might not have been healthy, whether we’re trying to cut back on sugar or cut back on carbs. What’s your advice to parents who might not be doing it right? What do you see that they grew up with that sometimes comes in that you’d like to nip in the bud?

Dr. Lisa Damour:

It’s really hard, Rena. I think there are very few women, especially walking around in the world who can say, I feel ambivalently great about my body. I mean, it’s just not how our culture allows us to feel. I mean, that’s just the reality of it. And so then of course one of the things we see is that kids are watching and hearing their parents often their

Talk about their weight, talk about what they’re trying to lose, talk about what they’re trying to cut out. And I would just say we want to be really careful. We have to deal with our own issues. I would say ideally on our own time. I do think though there’s a place, if we’ve gotten to a place where we can talk a about it, that especially these girls are 15 and 17 in this letter, you can start to have more sophisticated conversations. So another entry point for a conversation if these girls are talking badly about their bodies is to say, okay, it is really hard to be a woman in this world. And it is really hard given all of the messages, we all get bombarded with all day to feel good about our normal bodies that look like normal bodies. And I think a lot of adult women can say, I have struggled to come to a place where I feel good about my body. Some days are better than others, but there are things I really appreciate. It’s healthy for those of us who birth kids. It gave me you guys. It gets me everywhere I need to go. It feels good in various ways and I think we can say if we’ve gotten there, my job, I work really hard to take good care of myself, and I also work really hard to not be at war with my own body. I got a lot of other things I got to do. Being at war with my own body is not something I want to spend energy on. And honey, it’s not something I want you to spend energy on. So we can start there. What do you think?

Reena Ninan:

I wish you could enter into your own chat, GPT, which is the Lisa de more brain and give us an eating plan for teens and tweens because I am just at a loss. I don’t want to, you’re telling me don’t tell people you’ve reached your limit or cut out food groups, right? You’re saying that’s the road to an eating disorder. Don’t do that. But I do that sometimes like, okay, we’ve had enough sugar, we reached our limit. That’s enough. But you’re saying that is the rot to eating disorder if they’re reaching for the second bag of Doritos that are snack sized, is that so bad? I don’t want them to feel ashamed and I know they’re growing and they’re hungry, but I also would rather them reach for a banana with peanut butter. But it’s not how they roll.

Dr. Lisa Damour:

It’s not how they roll. Okay. But here’s a few phrases that could come in handy. Okay. If the kid’s going for the second snack size thing of Dorito, you could say, are you hungry or are you just wanting a treat? Right? I mean, I think that you can ask that as a fair, is it this or that? If you’re hungry, hungry, those Doritos are not going to get it for you. You need real fuel. And I think especially for kids who are athletes thinking about food as fuel is really valuable,

Reena Ninan:

That’s great.

Dr. Lisa Damour:

And if they’re asking for more food, you can say, are you still hungry? And if they are, feed them. And that is why I will tell you people in the eating disorder world hate calorie counting, especially with pubescent kids. Because I mean, I remember being a sophomore in high school. I grew three or four inches that year. I was teeny tiny and then I became average size. I was eating five meals a day. I was swimming, I was playing sports and I was eating five full on meals a day and I could not get enough food. And there’s a lot of parents raising kids who are going through that. So portion size, calorie accounting, no, it is entirely what people call intuitive eating, like helping kids tune in. Am I hungry? What am I craving? Am I listening to my body? Am I giving it what it needs and deserves?

Reena Ninan:

You know what we’re going to do on our social media on Instagram? Please go check us out at the Ask Lisa podcast. We’re going to crowd shop this. Tell me what your go-to healthy snack is for your kids. I need some help in having other options, especially if you’ve got an athlete or no matter who you have at home. What are your options? I’d love to know. Help me crowdsource this because I think it might help us if we can figure out other options to offer besides the snack sized Dorito bag, we can build out our anytime choices and have them be delicious. I love that. So ultimately, I want to come back to this letter. Is there anything this mom can say or do that won’t hurt this situation? What would be your final advice to her?

Dr. Lisa Damour:

I think clearly she’s so thoughtful, right? I mean, it’s just incredible how thoughtful our listeners are. I just am so grateful. I also think maybe a way to approach it that can help is to wait till there’s an opening. Wait until the daughter says or does something that indicates discomfort with her own body. And then to just say, I hear that. How can I be helpful? Might be a way to say more than nothing, but not step in it.

Reena Ninan:

It’s almost like when you say to us sometimes they just want to voice things and they don’t want you to solve the problem fully, but maybe this is a little bit of both. So just say, I hear you. I hear you. How can I help solve the problem?

Dr. Lisa Damour:

Is there anything I can do to be helpful here?

Reena Ninan:

Is there anything I can do to be helpful here?

Dr. Lisa Damour:

Yeah,

Reena Ninan:

I hear you. Is there anything I can do to be helpful? I love that. Absolutely love that. So what do you have for as Lisa for parenting to go?

Dr. Lisa Damour:

So when we look at the research on kids who are in good places with their body and with eating by and large, it helps a lot. If the family handles food and exercise well, so the parents themselves are eating a balanced diet. The parents themselves are enjoying foods, right? I mean, foods are fun. And where there’s activity that is fun and enjoyable as a family and not unpleasant, where exercise is like, let’s all go out for a hike or let’s go. I’ve been bike riding a lot since the summer and just spending time on bikes with my 13-year-old is my favorite thing to do. So back to my favorite saying in all of parenting, don’t talk about it, be about it. It’s a lot about what we model and how we live as parents in terms of shaping healthy conditions for our kids.

Reena Ninan:

Alright, I feel like we could do, I’ve learned so much, but I feel like we could even do another episode on this. So send us questions always to ask [email protected]. We’re always taking letters and looking at them, but boy, this got me a lot of things to think about and some things I’m going to change in the way we talk about food at home. So thank you, Lisa. You bet. And next week we’re going to talk about how should my son deal with the trash talking F friends he has. We’ll be taking that up next week. I’ll see you then, Lisa. I’ll see you next week. Thanks for joining us. Be sure to subscribe to the Ask Lisa podcast so you get the episodes just as soon as they drop and send us your questions to ask [email protected] and now a word from our lawyers. The advice provided on this podcast does not constitute or serve as a substitute for professional psychological treatment, therapy, or other types of professional advice or intervention. If you have concerns about your child’s wellbeing, consult a physician or mental health professional. If you’re looking for additional resources, check out Lisa’s website at Dr. Lisa.