It's always difficult to tell parents that their child has a problem requiring treatment. Even when the problem is readily apparent. And even if the parents were already concerned.
Sometimes, parents know what you're going to say and a part of them understands that it's true, but another part really, really doesn't want to hear it. Here's what I'd like to tell those parents:
I'm so, so sorry that you are going through this. An eating disorder affects the whole family. It's completely understandable that you'd prefer to view this as a simple nutrition issue that requires a simple nutrition intervention. I wish that were the case. But this is a serious disorder that can actually be life-threatening. If we want it to get better, we have to see it for what it is. And when it's a child or teen who has an eating disorder, there's no time to waste.
Secondly, THIS IS NOT JUST A SUCCESSFUL DIET. This is a life-threatening, life-altering psychological disorder. I wish I didn't have to say it like that, but it's the reality. I say "life-threatening" because eating disorders can affect every system in the body and have the potential to be fatal. I say "life-altering" because they can consume your child's thoughts on a daily basis for years to come and can cause long-term physical harm. One of the reasons eating disorders are so sneaky is that you can't always tell a child has one just by looking at her size. Many children with eating disorders may not appear to be underweight. Your child may have lost weight recently but not enough to make her appear "underweight", or she may have failed to gain weight appropriately. She may be engaging in binge eating and/or purging behaviors and her weight may not be significantly affected. It's critical to realize that being at a "normal" weight is no indication of health.
Eating disorders are associated with a host of medical complications. Many of them are reversible with treatment, but not all of them. Malnutrition causes hormonal changes that negatively affect bone density and increase the risk for osteoporosis, which may not be reversible. With each passing day of malnutrition, the risk for osteoporosis increases. We don't have any extra days. Childhood and adolescence are times of rapid development and adequate nutrition is essential during these years. Right now, your child is literally building her brain and bones for the rest of her life! She can't feel these changes and may not be thinking of the long-term consequences, but that doesn't mean they aren't happening. The adults in her life need to be considering her future health.
She may be more focused on the immediate physical effects of her eating disorder, which are numerous and include gastrointestinal problems, fatigue, cold intolerance, insomnia, and hair loss. She will likely hide these changes and restrict regardless. Some eating disorders include purging behaviors, which involve additional physical symptoms and risks, both to short-term and long-term health. If your child is purging, she is at risk for long-term complications, among them tooth decay, damage to the esophagus and kidneys, and dependence on laxatives. She may be in immediate danger of cardiac irregularities and heart failure.
A child who binge eats also faces potential long-term complications, including type 2 diabetes, high blood pressure, high cholesterol, and gastrointestinal complications. Binge eating may induce powerful feelings of shame and is associated with depression and anxiety. In general, eating disorders and mood disorders are strongly correlated. That alone is a critical reason not to let an eating disorder go untreated. The amount of time and energy a child spends on maintaining the disorder is time stolen away from a regular childhood, and when it is compounded by depression or anxiety, you have a child who is carrying the burden of additional suffering. And this suffering is real. One in five anorexia deaths is by suicide.(1)
With each day that your child continues his disordered behaviors, his unhealthy mindset becomes stronger. The eating disorder gains more of a foothold, which means recovery becomes increasingly difficult. This is a very, very hard thing to undo. And it's not only a matter of habit; malnutrition creates cognitive changes that make it harder to reason with someone with an eating disorder. Your child's thinking will become more rigid and inflexible. There is, literally, not a moment to lose.
Lastly, be aware that by allowing the disordered behaviors to continue, you are colluding with the eating disorder. This means that the unhealthy voice inside your child's head now has outside support. Even if your child may have doubts or concerns about what he's doing, if he sees that you are not taking action, he will ultimately think, "See, I'm really fine. There's nothing wrong with what I'm doing. If my parents aren't concerned, then obviously I'm OK." Recovery means helping your child find his healthy voice and supporting it with your own voice and with your actions. Treatment is available. There are caring, knowledgeable professionals who can help you help your child. Don't wait. Your child's present and his future are at stake. He may not admit to it, but he's counting on you. You are is greatest ally, and by taking the steps to help him recover, you are modeling for him what he needs to see most - what it looks like to be brave.
We're rooting for both of you.
1. Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731.