Once And For All: Do Parents Cause Eating Disorders?

"It's not the media or skinny, out-of-proportion Barbie dolls or even peer pressure that is the No. 1 cause of body issues for young girls. It's their mothers." —USA Today, 2013

Not long after the American public learned about eating disorders in the 1970s, we also learned that parents — mothers specifically — cause them. In 1978, German psychologist Hilde Bruch, still considered a pioneer in the treatment of anorexia, published the book The Golden Cage, in which she theorized that the condition was caused by mothers so controlling that they didn’t allow their daughters to develop a separate sense of self. The idea that a particular maternal style triggered eating disorders spread quickly; the title of a scholarly article published in the Journal of the American Academy of Child and Adolescent Psychiatry in 1983 was “Varieties of parenting failure in anorexia nervosa.”

By the late ‘90s, the narrative had evolved to suggest that parents negatively impact their children’s eating not through emotional enmeshment but through their own attitudes about food and weight. Today many mothers are still hyper-aware of everything they say about food and their bodies within earshot of their children. That’s probably a good thing for these women’s body image and well-being as much as for their kids’. But is it preventing eating disorders?

As it turns out, there is no evidence that parental behavior causes eating disorders. “Parent[s] have been blamed for eating disorders erroneously for decades,” Cynthia Bulik, Ph.D., founding director of the University of North Carolina Center of Excellence for Eating Disorders, told me over email. New evidence has emerged over the last two decades about what causes a person to develop eating disorders. Most striking was the discovery that genetics account for somewhere between 40 and 60% of one’s likelihood to develop an eating disorder.

Eight genetic markers associated with anorexia nervosa were identified in 2019 by Bulik, probably the world’s pre-eminent eating disorder researcher, and her team, who are now working to do the same for other eating disorders including bulimia nervosa (BN) and binge eating disorder (BED). Their findings reinforced scientifically what clinicians who treat eating disorders have observed anecdotally in patients’ family histories for years: eating disorders are moderately to highly heritable. Sometimes a patient has a parent with an eating disorder, but it can easily be a cousin or an aunt.

What if most parents who feel desperate to save their children from the pain of an eating disorder are actually desperate to protect them from the effects of diet culture?

In contrast, researchers haven’t found any evidence that parenting style or parental behavior causes eating disorders, and not because they haven’t looked. “There has been a lot of research looking at the causes of eating disorders,” says Aileen Whyte, Ph.D., a clinical assistant professor at Stanford University School of Medicine, who treats eating disorders using Family Based Treatment, a leading, evidence-based approach that deputizes parents to lead their children’s recovery.

In one sense, this is good news for parents, and mothers especially (finally, one thing is not our fault!). But many mothers I know, especially those who have struggled with food, weight, or body image themselves, want one thing for their children above all the other things: for them not to have an eating disorder. Even if we don’t cause them, it feels imperative to prevent them — thus the multitude of articles on the internet about how to do just that. “Set a good example.” “Eat dinner as a family.” “Do not talk about your dieting,” instructs a 2007 article in Today’s Dietitian. “Model good eating,” a parenting site directs, as though we all know and agree on what that means.

The advice in those articles is “perfectly sensible,” Whyte says, but following it will not prevent your kid from developing an eating disorder, and it can make parents of kids with eating disorders feel like they didn’t do enough when, as Whyte puts it, “We just don't know that it's anything parents do."

Whether you find this information comforting or distressing, it’s complicated by the fact that many coaches who work with adults with disordered eating say parents absolutely shaped their patients’ attitudes and behaviors around food — most often by shaming larger bodies (their own, their child’s, or other people’s) or by restricting their child’s food intake. “The vast majority [of my clients] were exposed either to their own parents’ dieting and or to their own parents commenting on their food behaviors and their bodies. Even if the comments weren't directed to them, [they] remember their parents talking about other bodies, larger bodies, in a negative way,” says Alissa Rumsey, a New York City-based-dietitian, intuitive eating coach, and the author of the book Unapologetic Eating. “To say that encouraging your kids to diet, and all of these things that lots of parents are doing, have no impact on whether or not they will develop or be predisposed to eating disorders, is just completely blind,” agrees Isabel Foxen Duke, a San Francisco-based body image coach, whose own mother, on the instruction of her pediatrician, put Duke on a diet when she was a child. “It’s denial.”

Like Bulik and Whyte, the coaches don’t blame parents. Instead, both Rumsey and Duke point to “diet culture,” a term many anti-diet activists use to describe a society-wide obsession with weight loss, to the point that it is viewed as a constant goal and as a solution to unrelated problems. According to Christy Harrison, a Brooklyn-based eating disorder dietitian, podcaster, and author of the book Anti-Diet, it’s the result of the convergence of multiple forces over the past century, most recently the massively popular fad diets of the 1970s through 2000s that made people terrified of fat, then carbs; the panic over obesity rates, especially in children; the wellness industry’s subtle (and not-so-subtle) equation of thinness and restrictive eating with health; and the ongoing and increasing stigmatization of fat people.

"What we can model is the difference between disordered eating and eating we don't have to overthink.”

Given the reach of diet culture, a parent putting a child on a diet probably isn’t trying to harm them, Duke says. “It's not like women are thinking out of nowhere, 'Maybe it would be fun to restrict my kid's food.'" Instead, they may be trying to teach them how to maintain a thin body and thus protect them from the many penalties imposed on those who are fat. Still, how could restricting your kid’s eating not warp their long-term attitudes toward food?

People with all sorts of challenging upbringings do not develop eating disorders, Bulik points out. If any childhood event (trauma, for example) were to make it more likely that someone with a genetic predisposition develops an eating disorder, that could happen through epigenetics, the phenomenon by which environmental factors can influence the expression of genes. Bulik underscores that research on epigenetics and eating disorders is still in early stages, but she is optimistic that it might help us understand how culture and genetics interact among the many factors that contribute to eating disorders.

Clinicians have long observed that eating disorders are often preceded by a diet, or at least a “negative energy balance” where the patient is taking in fewer calories than they are expending. If research were to reveal that these deficits activate certain genes linked to anorexia, Bulik says, “then we could argue that the reason dieting happened in the first place was due to cultural factors” — e.g., diet culture, in and outside the home.

Even if that turns out to be true, and your behavior plays some role in triggering one eating disorder gene in your child, your kid isn’t guaranteed to have an eating disorder. "Genetic risk lies on a continuum — so a person can have high or low genetic risk,” Bulik says. “Someone with high genetic risk might only need (for example) a little push from society (like one diet) in order to develop an ED; whereas someone with low genetic risk might require a much more forceful push (multiple diets, teasing, bullying, abusive experiences).”

What if most parents who feel desperate to save their children from the pain of an eating disorder are actually desperate to protect them from the effects of diet culture? Nine percent of Americans will have an eating disorder in their lifetime, but many more spend a lifetime struggling with self-loathing and a fear of food brought on by the pressure to lose weight or stay thin. Maybe that pain, and behaviors associated with it, are what concerned parents are actually trying to spare their kids.

If that’s true for you, experts say there are ways to dial back your participation in diet culture, if you’re willing to ditch some of the most entrenched ideas around feeding your kids. Here are some steps you can take:

Stop performing “healthy eating.”

It sounds like heresy to tell people to stop worrying so much about “healthy eating,” but when parents say they want to model a healthy diet, Emma Wright, an anti-diet parenting coach in New Zealand, asks them what they mean by “healthy.” “What are we considering 'healthy eating'? If you sit 10 dietitians down, they will not be able to agree.'" The lack of consensus around what exactly constitutes “healthy eating” does not mean you and your family should eat unlimited processed food and candy; it’s a reminder that when we decide that some foods are “healthy” and others are “unhealthy,” those labels are subjective, and using them has not improved our overall quality of life. Instead, it has had the opposite effect.

Wright advises an approach to feeding kids that contrasts virtually all food marketing and packaging, not to mention recent public health campaigns: don’t think too much about the nutrition content of specific foods — for yourself or your kids. When planning meals, go for variety, try to represent the major food groups, and then focus on the actual food as little as possible, Wright says. "What we can model is the difference between disordered eating ... and eating we don't have to overthink.”

Aim to raise a competent eater.

“All parents want their child to be a ‘healthy eater,’ but the problem is that the word ‘healthy’ has been reduced or diminished to mean not eating certain foods,” says Carol Danaher, a registered dietician and faculty member at the Ellyn Satter Institute. Instead, go for what the Satter Institute terms "competent eating." A child who is a competent eater:

• Will try some new foods (though they may still be “picky”; picky eaters can still be competent eaters).
• Can come to the table willingly.
• Listens to their internal cues around hunger and fullness.
• May eat a lot at one meal and not much at the next.
• Enjoys the context of the meal — the company, conversation, setting, and/or occasion.

If you recognize the Satter name, it’s probably because she is known for developing an increasingly popular approach to feeding called Division of Responsibility: the parent’s role is to choose what to serve when, while the child decides whether to eat it, and if so, how much. According to recent research, feeding your kids this way is associated with higher eating competence.

Never restrict a child’s food, even if they gain a significant amount of weight.

In a world where overweight kids are almost automatically judged, bullied, and excluded, having an overweight child can arouse a whole range of emotions in parents. Still, it’s imperative to resist the urge to control your kid’s food, Wright says. Withholding food leads to binging, hiding food, or both. “We can't make our child a certain size, as much as we might like to. We can't make them a sexual orientation, we can't make them have certain abilities, even though some of the things kids are makes life more painful. We want to protect them, and we can’t.”

Don’t refer to specific foods as “bad,” “junk,” “sinful,” “trashy,” or as being indicative of poor self-discipline. "It's very hard to help your child have a healthy relationship with food when you're demonizing food," Wright notes.

Embrace all body types.

If you want kids to be aware of and comfortable with different body types, make sure those body types are visible and not stigmatized, says Lauren Mulheim, Psy.D., an eating disorder psychologist in private practice in Los Angeles. That includes the people in your life, the media you consume, and the images around your house.

Don’t focus your praise on how people look.

Compliment others on their internal attributes — really. Chances are this is a value you already embrace, but pay attention to how many times you greet people with a compliment about how they look.

Wright argues that our obsession with weight is at its root an obsession with appearance and status. Subverting that focus can be as simple as not complimenting people on their looks or possessions when you greet them. “Let's make our greetings about how great it is to see you as a person, how that makes my day,” Wright says. “Kids internalize, My value isn't really in how I look. [...] What we can do as parents is we can give them another narrative that they can consider.”

To be clear, even if you take all of these suggestions to heart, your child could have eating issues, even severe ones. “There are families who have wonderful attitudes towards eating and weight whose children still develop eating disorders,” Bulik says. “Children are exposed to many more influences than just their parents."

But treating food and weight as non-issues in your household — a huge and transgressive undertaking — will almost certainly create a happier environment for you and the rest of your family, and it could make recovery easier for the kid who does develop an eating disorder. Take Harrison, the author of Anti-Diet, who grew up in what she describes as a nearly food-neutral household. Harrison says that even though she went on to develop an eating disorder in her 20s, "that foundation that my family built really served me well to be able to click back into intuitive eating relatively quickly. It still took years, but [for] some of the people I see, it's taken decades. I think that foundation can still do a certain amount of good.”

CLARIFICATION: An earlier version of this story did not mention that Isabel Foxen Duke’s mother put her on a diet at the instruction of her pediatrician. The story has been updated.