Addressing eating disorders: Balancing healthy bodies with healthy body image

By Kayla Gahagan

Abbie Lambert remembers the first time she struggled with nutrition and body image distortion. She was 11, in middle school, and newly diagnosed with gluten intolerance.

“I was at that place when kids start to become aware of their bodies and might start to see food or their body as something to fear,” said Lambert.

Her experience led her to a love of nutrition and a desire to help others. She’s now a registered dietitian for Monument Health and passionate about helping families maintain healthy conversations around body image.

An estimated 9 percent of the U.S. population, about 28.8 million Americans, will have an eating disorder (ED) in their lifetime, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). 

Worldwide, 22 percent of children and adolescents (ages 12-24) have disordered eating habits.

Eating disorders have the second highest mortality rate of any psychiatric illness, behind opioid addiction.

The Challenges

Curbing those numbers will hinge partially on honest conversations about diet culture, said  Sarah Granelli, a licensed South Dakota clinical social worker who works with patients with eating disorders.

“Diet culture is everywhere, and it’s different than what we experienced in the 90s with the Kate Moss look and her idea of ‘nothing tastes as good as skinny feels,’” Granelli said. “It’s more subtle, but in some ways, more insidious now. It’s sneakier – do the detox, the clean eating, the fads that say to fast or cut out an entire food group. It’s rebranded itself to not seem as bad, but it’s the same message – you need to lose weight and cut out certain food groups. The people behind the ads want you to dislike your body. Feeling good in your body and doing what you want to do is what we want to celebrate.”

Lambert and Granelli are part of a small segment of the state’s medical community working specifically with eating disorders. South Dakota does not 

have an eating disorder treatment center and though insurance companies may cover treatment, it’s rarely for as long as is typically needed to achieve full weight restoration and maintenance along with behavioral interruption. Both of those are necessary for a lasting recovery, Granelli said.

The lack of resources is frustrating, said Granelli, who is also licensed in Montana and has actively recruited fellow social workers to get licensed in South Dakota to do virtual outpatient care.

“It’s awful,” she said. “I’m one of a handful of ED providers in the whole state. A lot of times, if it’s serious enough, people end up going out of state. That makes me angry that we don’t have better care. It’s a massive undertaking to get treatment for patients.”


The greatest prevention tool specifically for youth, Lambert said, is listening and asking questions. Open discussions about culture, trends and what your students are hearing in school are important.

“Parents don’t have the power to give their kids an eating disorder,” she said. “It’s so multi-layered. There’s a genetic piece, cultural, societal, the atmosphere they’re in.”

But on the flip side, parents have a lot of power to do good, Granelli added.

“Diet culture is like a cult into which most people have been indoctrinated into by normalizing hating our bodies,” she said. “Parents can actively help challenge that and give their kids tools to see their bodies with neutrality and acceptance, instead of with criticism and punishment.” 

Lambert said home is the best place to set the example.

“Ask yourself, ‘what is the culture I’m creating around food in my home?’” she said.

The way parents talk about their own bodies is often picked up by kids. Modeling self-acceptance and talking to kids about what food does for your body is key.

“Remind them that their bodies are going to change and look different,” she said. “Our personalities are all different, so our bodies are going to be different as well.”

Parents can shape conversations, which help shift mindsets and habits, Granelli added.

“We can celebrate the body for what it does, not what it looks like,” she said.” If your child points out ‘that person is skinny,’ you can ask ‘but does that person being skinny help them perform better? Does it make them a better person?’ We want to encourage our kids to understand being skinny isn’t an indicator of morality and we need food to fuel our bodies.” Diagnosing and treating eating disorders is complex, she said, and Lambert agreed.

“It’s not just about adequate nourishment,” Lambert said. “It’s culture, tradition, holidays, social memories and more. Food is about all those things.”

The goal, she said, is helping your kids have a well-balanced, positive relationship with food.

Disordered Eating

Before experiencing a full-blown eating disorder, most patients will experience disordered eating, which is developing habits of an eating disorder like cutting out major food groups.

Not every person who has disordered eating gets an eating disorder, but every person who has an eating disorder started with disordered eating, Granelli said.

Eating disorders can go unnoticed until a drastic symptom happens, like a physical at the doctor’s office reveals a very low heart rate.

“Eating disorders are secretive so no teenager comes out and says, ‘I hate my body and I’m not eating,’ or ‘I hate my body so I’m going to the gym for two hours,’ or ‘I hate my body so I’m throwing up,’” Granelli said.

Symptoms can mask themselves as a general medical problem, including an allergy or a problem with gluten.

“I’ve seen where maybe they have a slight intolerance to gluten and then cut it out and then their body really can’t have it,” she said. “They lose weight and get positive reinforcement from that.”

“The normal person is not thinking, ‘my child’s stomach hurts, they must be restricting,’” she said. “If you have gone through the ringer and it’s not medical, it’s something to consider.”

The Myths and Misconceptions

Fewer than 6 percent of people with eating disorders are medically diagnosed as “underweight” or live in a small body. In fact, statistics show that people who live in larger bodies are at the highest risk of developing an eating disorder during their lives. 

Stereotypes for eating disorders also surround women. Men also struggle with disordered eating and eating disorders.

“It’s probably far more than we know, but women seeking mental health treatment is so much greater,” Lambert said.

Women exhibit a full range of symptoms while symptoms among males can show up in excessive exercise habits.

“The majority of what determines body size and shape is genetic – some have bigger bodies but are at an optimal level of health,” Granelli said. “No two genetics are the same.”

Granelli said she focuses on reminding patients, and her own family, that no food is inherently good or bad.

“All foods fit,” she said. “That conversation shifts as your kid grows, but early on, instead of saying that carrots are healthy, say that carrots have Vitamin A and that helps your immune system.”

“We have a kindergartner and we never make anything off limits,” she said. “We say, ‘you can have chocolate chips, but they don’t have the nutrients and minerals like an apple. A cupcake tastes good. It gives you a short burst of energy, but you would feel yucky later if that was the only food you ate to give you energy.’ Everything has a place. If you only ate broccoli, your muscles will wear away.”

Lambert agreed. Finding a balance is hard, she added, as parents try to encourage healthy eating, while also encouraging a healthy body image.

“Education is important but don’t demonize food,” she said. “You can have chocolate and veggies and carbs on your plate. They all have a place.”

For teenagers, teaching them to eat intuitively is the best way to help them develop healthy habits alongside a healthy body image, Granelli said.

“For older kids and teenagers, OK, you had two Big Macs and a ton of french fries, how did you feel at cross country practice?” she said. “Give them that chance to explore and figure out what works for them instead of telling them not to eat certain foods or labeling foods as ‘unhealthy’ or ‘bad.’”

Model Health

Lambert is hopeful South Dakota will someday have more resources and providers for people struggling with eating disorders.

“We have the most basic level of care and that’s out-patient therapy,” she said. “It’s complex because it’s a mental health diagnosis with medical complications. It really needs an interdisciplinary team.”

The first step always starts at home, though.

“Changing the way you talk about food and bodies can have a profound and positive impact,” she said. “We can’t control what they’re hearing at school, in their sports teams and by well-intended coaches, but we do have the power to shape conversations to serve as a buffer for what they are hearing that’s unhealthy.”

Eating together as a family is so important, Granelli said.

“Try to eat together, with no screens and building the habit that we are mindful when we eat,” she said. “If you are mindful, you’re doing one thing at a time. You know when you’re full. You’re helping your kids to be in tune with their bodies.”

“What we want is for our kids to eat intuitively,” Granelli said.  “Eat when you’re hungry and stop when you’re full. And you will feel the best when you’re having balanced meals with all the food groups.”

Adolescents face body changes, and it’s about helping them manage the complex feelings that stem from that.

“Those feelings don’t have to be part of the pervasive diet culture,” she added. “They can feel weird during puberty, and even uncomfortable. We need to normalize that it’s OK to feel uncomfortable.”

And then as parents, help reframe the conversation.

“Ask them, what can this new body do – run faster?” she said. “Let them know, it’s normal to have body changes, but it’s not normal to hate your body.”


In person – take your adolescent to their pediatrician for regular checkups

Website: F.E.A.S.T (or

Book: “Anti-diet” by Christy Harrison

Instagram page: Kids Eat in Color

Podcast: Food Psyche