My Daughter Is Losing Weight and Says She’s Fine: When Should I Be Concerned?

Written by Dr. Colleen Reichmann, owner and clinical director of Wildflower Therapy

There is a particular kind of parenting anxiety that is hard to explain unless you have lived it. It’s one that usually starts out as a neutral observation. You notice your kid is eating differently.

Maybe she has stopped eating breakfast. Maybe she suddenly has a long list of foods she “doesn't really eat anymore.” Maybe she's randomly started running every day, or asking to go to the gym after soccer practice, or becoming intensely interested in nutrition.

And then… you notice that she's losing a little bit of weight.

You ask her about it. She says she's fine. She tells you she's eating enough, that she’s just trying to be healthier. Maybe she even seems proud of the changes! Other adults might be complimenting her. A friend might tell her she looks amazing. Her pediatrician might say that her weight is still technically within a “normal” range. There are lots of signs that point to “Hey. Don’t make a problem out of nothing here.”

But you can’t shake the worry. You find yourself standing in the kitchen looking at her shoulder blades that seem just a smidge sharper and thinking, “Something about this doesn't feel right.”

If you're wondering whether your kid’s dieting or weight loss could be a sign of anorexia, you're not being dramatic for paying attention. You also don't have to wait until she looks extremely thin, admits that she has an eating disorder, or agrees that there is a problem before you take your concerns seriously.

When does dieting become anorexia?

This is one of the hardest questions parents ask us. Because teenagers diet. Teenagers become interested in exercise. Teenagers try new ways of eating. And of course, none of those things automatically mean that that they have anorexia nervosa.

We always say that it’s good to put your extra antenna up as a parent when you notice any changes with food, exercise, or weight changes in your child. But the piece that is really important to look out for is when food, weight, exercise, or body shape seem to start taking up a significant amount of mental and emotional space.

You may notice that your daughter is becoming increasingly rigid about what she will eat. She might eliminate carbohydrates, desserts, fats, or entire categories of food. She may start measuring or tracking everything she eats. Meals that used to be easy become just a little bit more stressful. You start to feel like there is weird tension around the “what’s for dinner” question that didn’t use to be there. She may become increasingly anxious about eating something she considers “bad” or “unhealthy.”

Exercise can change, too. Maybe she is exercising even when she is exhausted or injured. Maybe she becomes distressed when she has to miss a workout. Maybe movement starts to feel less like something she enjoys and more like something she has to do.

But truthfully, sometimes the biggest change is in the emotional atmosphere around food.

Your kid may become irritable when you ask her to eat. She may become upset when plans involve restaurants. She may start avoiding family meals. She may insist that she already ate. She may spend a lot of time looking at herself in the mirror, checking her body, comparing herself with other girls, or talking about how much she “needs” to lose.

And again, none of these signs, by themselves, create an anorexia diagnosis.

It’s the amount, the frequency, the intensity, and how many of them together have accumulated that matter.

What if she says she is fine?

So please know, we understand this is where things can get especially confusing: A child with an eating disorder may genuinely believe that she is fine!

Eating disorders can change the way someone interprets what is happening to their body. The behaviors that look alarming from the outside can feel completely reasonable from the inside. So she may genuinely believe that she is eating enough, or that her exercise is healthy.

She may believe that losing another five pounds will finally make her feel comfortable in her body. Maybe you get the sense that she is actually a little frightened by the idea of gaining weight and unable to understand why everyone else seems so concerned.

The main takeway we want you to have is that when you ask, “Do you think you have an eating disorder?” and the answer is an emphatic no, that answer doesn't necessarily settle the question.

This is one reason early professional evaluation can be so helpful. Parents do not have to figure this out entirely on their own.

She doesn't have to look extremely thin

This is another one of those super important things I want parents to know about anorexia: You cannot reliably determine the seriousness of an eating disorder by looking at someone's body.

Some adolescents with anorexia become significantly underweight. Others do not. Simple as that.

A person can experience severe restriction, significant nutritional problems, intense fear around food, and serious medical consequences while remaining in a weight range that looks “normal” to everyone around them.

This is sometimes referred to as atypical anorexia nervosa. And because our culture tends to celebrate weight loss, this can become particularly confusing for families. Because maybe your daughter loses weight and people tell her she looks great. She gets all the compliments from friends, and her coaches praise her for being “so disciplined.”

Maybe she receives positive feedback from adults who have no idea what is happening underneath the weight loss. Meanwhile, she is eating less and less, thinking about food constantly, becoming increasingly afraid of gaining weight, and struggling to function without following her rules.

This is why I wish everyone could deeply internalize the fact that weight loss is not automatically evidence of health. And that a person does not have to be underweight to need eating disorder treatment.

What if she says she is just trying to be healthy?

This one comes up constantly. And honestly, it can be a very difficult conversation because the language of eating disorders and the language of wellness can look remarkably similar.

“I just want to eat healthier.”

“I've been learning about nutrition.”

“I don't feel good when I eat sugar.”

“I want to cut out processed foods.”

“I feel better when I don't eat carbs.”

“I've just been exercising more.”

Sometimes those statements are exactly what they appear to be. Sometimes, though, they are the beginning of a much more rigid relationship with food and exercise.

The question isn't simply one that asks, “What foods is she eating?” It becomes more of a “What happens if she can't follow the rules?”

Can she eat at a friend's house without becoming overwhelmed? How about birthday cake without compensating afterward? Can she take a rest day without crippling anxiety? Can she go on vacation without worrying about food (and essentially high-jacking the trip for the rest of the family)?

Can she eat something that isn't “perfectly healthy,” or tolerate changes to the plan around food that day? Can she sit through a family dinner without calculating what she has eaten?

That flexibility piece tells us SO much

What about high-achieving girls?

Some girls with eating disorders are very good at looking like they are doing well.

They are getting good grades. They are showing up to practice. They are responsible. They are conscientious. They are organized. Sometimes they are the child everyone describes as mature for her age.

That can make an eating disorder MUCH harder to recognize. Because perfectionism can become tangled up with food and body image. A girl who is already used to holding herself to extremely high standards may approach eating in the same way. There is a right way to eat. A wrong way to eat. A number of calories that is acceptable. A number that feels terrifying. A workout that counts. A workout that doesn't.

Eventually, the rules can become incredibly restrictive. But if she is still succeeding at school or athletics, adults in her life (including parents, understandably!) may assume everything is okay.

But if your daughter is high-achieving, anxious, perfectionistic, or deeply self-critical, changes in eating and exercise deserve attention even when the rest of her life appears to be going well.

When should a parent seek help?

You don't need to wait for a crisis. I would encourage parents to reach out for an evaluation when you are seeing a meaningful change in eating, weight, exercise, body image, or behavior around food and you're having a hard time figuring out what is happening.

That might mean your daughter is losing weight quickly, or that she just seems to be becoming increasingly restrictive without noticeable weight changes. It might mean she is terrified of gaining weight. It might mean she is exercising compulsively. It could also mean that family meals have become a daily battle. It might mean she is increasingly distressed by her body.

Or it might just mean that your gut is telling you something has changed. That gut instinct is important. We take it seriously at our practice.

What does anorexia therapy actually involve?

As you can probably predict, anorexia treatment is much more involved than simply telling a teenager to eat more.

Nutrition and physical health matter enormously, and restoring adequate nutrition is an important part of recovery. At the same time, effective eating disorder treatment also has to address the psychological pieces that are keeping the disorder in place.

That can include fear of weight gain, rigid food rules, perfectionism, anxiety, body image distress, compulsive exercise, shame, and the ways an eating disorder has begun to affect friendships, school, sports, and family life.

For adolescents, parents can be an incredibly important part of treatment. Depending on the child's age, symptoms, and family circumstances, treatment may include significant parent involvement and elements of family-based treatment.

For older adolescents and adults, therapy may look different. We might spend more time helping someone understand the eating disorder's rules, challenge those rules, increase flexibility around food and movement, and rebuild a relationship with their body that isn't organized around constant monitoring and control.

The treatment plan should fit the person sitting in front of you.

At Wildflower Therapy, we provide specialized anorexia therapy in-person in both Philadelphia and Devon, or virtually for clients across Pennsylvania and various other states. We work with children (ages 5 and up), adolescents, college students, and adults struggling with anorexia, restrictive eating, body image distress, and related eating disorder concerns.

What if I'm still not sure?

This is probably the most important part. You Do. Not. have to be certain. Your concern is enough.

You can tell her, “I'm noticing some changes and I want to understand what's happening.” And then schedule a consultation.

You can seek an eating disorder evaluation even if your daughter insists that everything is fine. If she is resistant to therapy at first, that doesn't mean it can't work. It is very common for a teenager to have mixed feelings about getting help! Honestly, the teenagers that are really excited to get started at our practice are the exception, not the rule. Part of the work is helping her understand what the eating disorder is doing, why it feels compelling, and what she stands to gain by loosening its grip.

You don't have to wait until you are completely sure that something is wrong. Again, sometimes the first step is simply saying, “I've noticed some changes, and I want to understand them.”

If you're looking for anorexia therapy in Philadelphia, Devon, or virtually throughout Pennsylvania, please do not hesitate to reach out to us. Learn more about our team here at Wildflower, our specialized anorexia therapy in Philadelphia or Devon, or just reach out today to book your free 30 minute consultation call with the practice director (That’s me! Dr. Colleen Reichmann)

Remember-your child doesn't have to look “sick.” You don't have to prove that she has anorexia. You don’t need her to enthusiastically endorse getting help. And most importantly, you don't have to figure it out alone.