1. What led you to write this book?
   Through the years I have seen a great many eating disordered children and adolescents who had met with treatment failures elsewhere. Invariably parents have been excluded from the treatment process, leaving them feeling defeated and lost. Warned to back off, parents were led to believe that their participation in treatment would be intrusive, violating the child’s autonomy as well as patient/therapist privilege. I wrote this book to dispel these myths and to create a blueprint for parents to follow in rekindling the kind of emotional connections that would facilitate a child’s effective and timely recovery.
   
   
2. Who is this book for?
   This book is for parents, patients, health professionals and school personnel alike; it is not just about kids with eating disorders, but about healthy kids as well, advising parents how to keep them that way by preventing disease. In fact, many of the people who would benefit from reading this book have probably not yet identified themselves.
   
   
3. What are eating disorders?
   Anorexia, bulimia and binge eating disorder are not so much about food and eating as they are a misuse of food to solve emotional problems. By controlling food, the victim attempts to take control of what feels to her to be an otherwise out of control existence. The behavioral tip of an emotional iceberg, an eating disorder can derail a child’s healthy maturation into adulthood. As coping devices and problem-solving tools, they provide illusory, pseudo-solutions for real problems.
   
   Disordered eating is not the same as an eating disorder. The distinction between normalcy and pathology lies in the purpose of the behavior for the individual. Problems exist when food- or weight-related behaviors determine the quality of a person’s mood or emotional functioning. Skipping breakfast because a person is late for school is different from missing breakfast in order to feel in control and confident that day. An eating disorder simultaneously impacts a person’s emotions, behaviors, and physical health.
   
   
4. Who gets eating disorders?
   Eating disorders cross all boundaries of gender, class, and ethnicity, striking young and old, rich and poor, males and females; recent studies have shown these diseases prevalent among African American, Hispanic and American Indian populations. Upward mobility is the most significant determining factor for minority groups.
   
   There are reported to be 7 million women, and 1 million men with eating disorders in the U.S. today; the number of men has doubled in past 10 years.
   -Though eating disorders mainly strike adolescent girls between the ages of 13 and 17, kids between ages 9 and 12 are now at risk for disease. Body image concerns are reported in the first grade, and by the 8th and 9th grade half of all girls have been on diets, a major risk factor for developing an eating disorder.
   
   
5. What causes eating disorders?
   There is increasing evidence that the roots of disease lie in genetics, brain chemistry and temperament, as well as in environmental factors. Though parents are the not the cause of their child’s eating disorder, their personal attitudes, issues, and relationship with food and weight (skipping meals, restricting food) may become a contributing factor or trigger to an eating disorder in an already susceptible child. By the same token, parents can be influential in preventing eating disorders in their children.
   
   
6. Why are there more eating disorders today?
   We live in a thin-is-in society, obsessed with changing and conflicting notions about what constitutes healthy eating. Restrictive or fat-free eating is not healthy eating, The compulsive checking of nutritional labels for guidance and permission to eat creates compulsions and food phobia, not healthy bodies and eating lifestyles.
   
   The structure of the American family has changed. Parents are out working, or are working out, too often leaving children to fend for themselves, without nutritious home cooked meals and the communal family experience that exists around them.
   
   Parents are fast losing connection with their children. We live in an increasingly excessive and apathetic, unparented society, where 65% of children have televisions in their rooms and spend approximately 5 1/2 hours a day in front of some form of technology. Parents today spend 10 hours a week less with children than they did in the 1970’s.
   
   
7. What can parents do to prevent disease?
   * Know what early signs to look for and how to identify them when the child is at risk.
   * Look for signs in emotional functioning, as well as in food-related behaviors.
   * Be parental, providing limits that children can internalize so that they can eventually become self-regulating and not need an eating disorder for control.
   * Stay emotionally connected with child, responding to his or her needs and concerns.
   * Know what healthy eating is. Model healthy eating through one’s own personal relationship with food and exercise. Eat meals together with your child and family.
   * Model the honest expression of feelings, and resolution of conflict. A child who is a good communicator and problem-solver becomes virtually "eating disorder proof. "
   
   
8. What are the early warning signs of eating disorders?
   Eating disorders evolve; a child does not simply wake up one day with an eating disorder. Recognizing early warning signs is the key to prevention.
   Early signs of disease may be seen in the child’s attitudes and quality of emotional function before they manifest themselves in weight loss or in food abuse.
   By the time a child’s physical appearance has been affected, the disease is likely to be entrenched.
   Diagnosis happens in kitchens and bathrooms, not in doctor’s offices. It is for parents to notice the clustering of such signs as
   *Extreme, excessive, inflexible or compulsive behaviors.
   *Rigid, black and white or perfectionistic thinking.
   *The child’s lack of self-awareness, self-control, self-esteem and self-regulation.
   *The child’s difficulty solving problems, coping with adversity, conflict or anxiety.
   *Body image concerns or distortions.
   
   
9. What should parents do when they see signs of an eating disorder in their child?
   Though it is the child’s job to recover, it is the job of the parent to provide permission and the opportunity to do so.
   Take charge, not control, until the child is capable of assuming responsibility for his or her own self-care.
   Learn whether and when to intervene.
   Stay involved with the child who needs support and understanding, modeling effective and proactive problem solving. Don’t back down; persist in the face of your child’s resistance to recovery. You can’t tell him what to do but you can tell him how you feel.
   Become involved in the treatment process. Find the best professional help from clinicians who will involve and embrace parents as part of the treatment team.
   Parents may need to become involved in symptom management in this age of managed care and limited professional care.
   Provide limits for the out of control child and a good example in your own relationship with food. Provide nutritious, balanced meals and eat them together with the family.
   
   
10. Why are eating disorders considered "family diseases?"
    Parents are responsible for the diagnosis of these disorders that tend to show up in home.
    Research out of the Maudsley Hospital in London England has shown that for youngsters living at home who have been anorexic for less than three years, the most effective form of treatment is family treatment. Families function as systems, and they need to be treated as such.
    Managed care is limiting the professional care that patients are entitled to these days. Even the most severely involved cases are being sent home from hospitals after 6 -12 days to recover alongside of parents and family. Parents may need to become symptom managers in some cases, much as nurses would be in an inpatient setting.
    
    
11. Don’t be taken in by the myths and misconceptions surrounding these diseases.
    These include:
    Diets are the best way to lose weight.
    Parents are the cause of their child’s eating disorder.
    Eating disorders are incurable.
    Anorexics are always thin and easy to spot.
    Parental involvement in a child’s food or recovery amounts to unwelcome and harmful interference.
    
    
12. Words of advice to parents:
    Don’t be afraid of your child, the eating disorder, the treatment process, your child’s professionals, or of making matters worse by raising the issue. A problem cannot be resolved until it can be clearly defined and understood.
    - Be your child’s parent.
    - Trust your instincts.
    - Listen to your child’s anger, to what she or he needs to communicate that you have not yet been able to hear. You and your child share a common goal - that he or she grow up to become a healthfully functioning and gratified adult.
    
    
    
    Abigail H. Natenshon, MA LCSW has been a psychotherapist in private practice specializing in the treatment of eating disordered individuals and their families for the past 28 years. She is co-founder and director of Eating Disorder Specialists of Illinois; A Clinic without Walls, and the author of When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers (Jossey Bass, San Francisco, October, 1999). Visit her web site at www.empoweredparents.com.
    
    

CONTACT:
Abigail Natenshon, MA, LCSW
Telephone 847-432-1795 Fax: 847-266-9233
Highland Park, Illinois 60035
www.empoweredparents.com
www.empoweredkidZ.com
E-mail: Contact Me