Please note that this is an Archived article and may contain content that is out of date. The use of she/her/hers pronouns in some articles is not intended to be exclusionary. Eating disorders can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights.

By Nikki Rollo, PhD, LMFT

I’m too short!

I’m not thin enough!

My nose is too big!

My hair isn’t straight enough!

I’m not smart enough!

I’m too awkward!

Most of us have either heard these phrases uttered by a teenager in our lives or remember having been a teenager with our own version of these thoughts. It is probably safe to assume that we have all have experienced insecurities, internal stories and judgments related to feeling not enough of something or too much of something else.

Adolescence is a particularly vulnerable time marked by role changes, achievement-oriented stress, and social anxiety. It is common to see a focus on having perfect clothes, the right kind of body, and being part of a popular friend group. Living in the age of social media has intensified this experience with endless options for edits and filters on pictures, access into the lives of celebrities, and the quest for likes, comments and ratings on appearance (Am I hot or not?!). Teens simultaneously want to fit into a common group and stand out as unique.

Insecurities about one’s place in the world can get projected onto our bodies. Beliefs about not being enough or being too much can quickly become negative thoughts and feelings about physical appearance, weight, shape and size. Individuals most vulnerable to negative body image and the development of an eating disorder are those for whom appearance and self-worth are conflated. When physical appearance holds a place of core importance for the individual, self-worth is undermined. Self-esteem becomes determined by how one feels about their body in any given moment. Negative feelings about one’s body means negative feelings about one’s value as a human.

This period of critical transitions is a time when experimental behaviors and risk factors collide. Comparison with others, struggling self-esteem, physical changes, and increased sociocultural pressures may provide fertile ground for the development of poor body images, susceptibility to dieting behaviors and disordered eating.

Eating Disorders are the 3rd most common chronic condition in adolescents. In 2016, the American Academy of Pediatrics reported that some teenagers who attempt to lose weight through dieting may develop an eating disorder. The peak age of onset for anorexia nervosa is early to middle adolescence and bulimia nervosa is late adolescence. This report indicated that dieting is counterproductive to weight management and is the most important predictor of development of an eating disorder. The authors recommended that pediatricians focus on promoting a healthy lifestyle and avoid weight-based language.

What is a “Healthy Lifestyle”?

The word “healthy” is wide open for misinterpretation. In our social media driven world it means things such as eating clean, eating raw, eating organic, excessively exercising, and restricting caloric intake for weight management. The hashtag #healthylifestyle brings up images of mainly raw fruits and vegetables, perfectly portioned meals, and many forms of extreme working out. Adolescents are spending a significant amount of time on social media and are influenced greatly by the messages and images received there. A teenager trying to eat “healthy” may begin to restrict certain foods or caloric intake. A hyper focus on health may lead to obsession with nutrition facts, excessive exercising, utilization of laxatives or self-induced vomiting.

Let’s take a moment to remember the real definition of health to guide us, rather than what social media and the diet industry are promoting as health behaviors.

Webster’s defines health as:

  • The condition of being sound in body, mind, or spirit
  • Freedom from physical disease or pain
  • A condition in which someone is thriving or doing well

Whether you are a therapist, educator, parent, or trusted adult with teenagers in your life, it is essential to have some ways to help teens feel good about themselves and their bodies in a hashtag saturated world.

How to Help Develop a Healthy Lifestyle

Teens require and deserve our unwavering support, love, and encouragement during this critical transitionary time in their lives. Nurturing their spirit and sense of self instills confidence and hope, essential building blocks for the future of our communities (and the world!) and helps develops protective factors against negative body images and disordered eating behaviors.

Instead of trying to “stop” or “reduce” something, we suggest a focus on “giving”. Giving our teenagers more support, empowering their innate goodness, teaching them skills, and promoting trusted relationships. It is essential to tell them what they have done right and include them in decision making.

Here are some ideas for what to focus on in your relationships with the teenagers in your life to help promote a healthy lifestyle and feeling good about themselves and their bodies:

Focus Less on… Focus More on…
Physical appearance Personality and character building
Exercise Joyful movement
Food as reward or punishment or good or bad Eating a variety of foods in response to hunger or a social situation
Conforming to societal pressures to fit in Identity development and healthy emotional expression
Weight management Cooking and eating together as a family
Counting calories Skills for life such as budgeting, resume writing, and filling out job applications
Social Media Relationships with family and peers
Media driven messages and the thin-ideal Critique of cultural norms
What is wrong What is right and how to ask for help
Deficits Strengths and engaging teens as leaders

Our youth need an abundance of support and encouragement from caring adults. It is important to tell the teens in your life who may be struggling with negative body image and a low sense of self-worth that they are good, they are enough and that their body is not the problem.


Sources of Strength, a comprehensive youth suicide prevention program that also targets substance abuse, is designed to build protective influencers around youth. Many of the elements may also be applied youth at risk for development of an eating disorder.

  • Family Support
  • Positive friends
  • Mentors
  • Healthy Activities
  • Generosity
  • Spirituality
  • Medical Access
  • Spirituality
  • Mental Health

To find out more about this program:

Guidelines for Treating Adolescents with Eating Disorders, developed by Michael Berrett , PhD, founder and CEO of Center for Change, speaks to the five most basic and critical needs of youth.

  1. A sense of acceptance and belonging in a social sphere
  2. A sense of being important and valued in the family
  3. A sense of spirituality, purpose, and meaning in life which gives hope
  4. A sense of self and identity
  5. A growing set of principles in which one’s life is anchored

For more on clinical treatment guidelines for clinicians:


Golden, Neville H,M.D., F.A.A.P., Schneider, Marcie,M.D., F.A.A.P., & Wood, Christine,M.D., F.A.A.P. (2016). Preventing obesity and eating disorders in adolescents. Pediatrics, 138(3)