Why ‘Wait and See’ is Not a Plan When It Comes to Disordered Eating in Children

I understand the temptation. When faced with something like food, eating or body image distress in children, it’s easy to worry that you’re overreacting. To tell yourself you’re being paranoid. It feels like something that happens in the movies, to other families, not yours. And besides, it’s not that bad, right? Every teenager worries about their body. Every child skips meals. Right? And you really don’t want to start another fight with your already on-edge teen.

And so when someone says, “It’s probably just a phase. Let’s wait and see.” It can feel like reasonable advice.

But the reality is:

Even though the advice "let's wait and see" comes from a well-meaning place… It’s rarely the right approach. 

In this article, I explain why.

“Wait and see” is not protective. It's not being respectful. And it's not acting in the child's best interest.

It is a missed opportunity for early, gentle intervention, the kind that can make recovery easier and prevent years of struggle later.

In this article, I will discuss:

• Why the “wait and see” mindset is not a good idea for disordered eating.

• What early signs are often overlooked, especially in neurodivergent kids, boys (eating disorder rates in males are increasing faster than for females), and athletes.

• How to respond with care and curiosity (without making it a battle)

• And why reaching out doesn’t mean overreacting. It means protecting what matters most: your child’s well-being

This article is for counsellors, health professionals, and parents who want practical, compassionate strategies for early identification and support in the care of young people with eating disorders.

After 20 years of working as a dietitian across a range of eating disorder presentations, this is what experience and evidence have taught me.

Why “Wait and See” in Disordered Eating Does More Harm Than Good

Twenty-two percent (22%) of children and adolescents worldwide show disordered eating (1).

Disordered eating isn’t all-or-nothing. It sits on a spectrum — and early patterns matter, even when they don’t meet diagnostic criteria. 

Waiting until things get “bad enough” can mean missing the window where small, supportive shifts make a big difference. For many families, by the time things feel urgent, the problem has already taken root, and the consequences are much harder to undo.

Eating disorders are serious, complex and potentially life-threatening mental illnesses which impact a person’s physical health, mental health, and holistic wellbeing. Eating disorders are currently a public health concern in most mid- and high-income countries, and their prevalence in young people has markedly increased over the past 50 years. Eating disorder rates in young people are also increasing in Singapore. Furthermore, eating disorders are among the most life-threatening of all mental health conditions. (1,2,3,4)

In my experience, eating and body concerns rarely resolve on their own.

Here are 6 reasons why speaking up and intervening early is better than waiting.

1. The sooner we act, the better the outcomes

Early intervention can make all the difference.

When recovery support begins within the first 3 years of symptom onset, the likelihood of full recovery is high (2,3,4). In contrast, delaying support significantly lowers those chances.

The longer disordered eating patterns continue, the more they shape a young person’s thoughts, metabolism, and daily routines.

Over time, these patterns can become deeply ingrained, making recovery more complex and emotionally taxing for the whole family.

Researchers call this the duration of untreated eating disorder: the period between when symptoms first appear and when specialist, evidence-based care begins. A shorter duration of untreated illness is consistently linked to faster, more sustainable recovery (5).

All global clinical guidelines agree (2,3,4): early recognition and response are critical to improving recovery outcomes. 

Unfortunately, studies indicate an average delay of about four years between the start of disordered eating symptoms and the first treatment. In some cases, that delay stretches to a decade or more (1,4,5). For children and adolescents, early action is vital because they often experience the longest delays and the most significant health disruptions before receiving appropriate help (1).

In the next point, I discuss why there is often such a delay.

2. Many early eating disorder signs are missed or dismissed

Many eating disorders are missed early on — not because the signs aren’t there, but because we don’t always know what to look for, and we still hold very narrow ideas about what an eating disorder “looks like". Furthermore, in a society drowning in diet culture, disordered eating signs are often praised or seen as "normal".

According to the National Eating Disorders Collaboration (NEDC), many people experiencing eating disorders first present to healthcare settings with unrelated concerns. Things like persistent stomach discomfort, thyroid issues, amenorrhea, or low blood sugar. These underlying eating difficulties often go unrecognised, especially when the person doesn’t “look” unwell or fit common stereotypes.

This is particularly true for:

• Athletes or boys who may appear highly disciplined, focused on “clean eating,” or driven by body composition goals like muscle gain or leanness. These behaviours can disguise disordered eating patterns such as obsessive tracking, guilt around food, or training through illness and injury. (2)

  
  

• Neurodivergent children, whose rigid eating patterns, sensory sensitivities, or impulsive eating behaviours may be dismissed as “just how they are,” rather than explored as possible signs of distress. (2)

  
  

• Children in larger bodies are especially vulnerable to having their behaviours misinterpreted. A child who is restricting, skipping meals, or preoccupied with “healthy” food may be praised for “eating better” or “trying to be healthy”, even when they’re struggling. (2)

Disordered eating affects children across every weight, gender, and neurotype. It can hide under the language of “health,” “fitness,” or “discipline.” Recognising this helps parents and professionals look beyond appearance and focus on the thoughts, emotions, and patterns beneath the surface.

Therefore, I recommend we always screen for eating disorders in high-risk groups like adolescents and young athletes.

Eating Disorders in Boys and Men

Eating disorders don’t only affect girls. Research suggests that around one in four people with anorexia or bulimia, and up to 40% of those with binge eating disorder, are male. In fact, a large study of adolescents aged 13–18 found no difference in lifetime rates of anorexia nervosa between boys and girls. (2)

Despite this, eating disorders in boys and men often go unrecognised. The signs can look a little different — and they’re frequently hidden under the language of fitness, discipline, or performance. (2)

While girls are more likely to express a desire to be smaller or thinner, boys often describe wanting to be leaner, fitter, or more muscular. Compulsive exercise is one of the most common compensatory behaviours seen in males — a rigid, driven urge to train that can push the body well past healthy limits (2).

This drive isn’t about professionalism, work ethic or motivation. It’s a warning sign that deserves to be taken seriously.

3. Eating disorders don't start overnight

Disordered eating exists on a continuum from subclinical patterns to severe eating disorders. Not all disordered eating patterns develop into eating disorders, but they still deserve attention. Recognising and responding early along that spectrum can prevent escalation and support recovery before medical risk develops, plus reduce unnecessary mental distress. (1,2)

You may not have a formal diagnosis, or even the right words yet, but what you’re noticing is real and worth paying attention to.

Disordered eating rarely fits a neat label. Sometimes it looks like rigid food rules, lots of exercise and after-dinner bathroom visits. Other times, it’s subtler — a shift in personality, growing black-and-white thinking, and social isolation. And often, it’s a bit of everything.

You don’t need to wait until you’re sure of a diagnosis to say something. Whether you’re a parent, counsellor, teacher, or health professional, your role is to notice, stay curious, and open the conversation early.

The saying “When you see something, say something” applies here. Early, gentle curiosity is far more protective than silence or hesitation.

When children don’t fit traditional diagnostic criteria, they’re often labelled as “not sick enough.” But sub-threshold eating disorders (where someone has clear symptoms but doesn’t tick every box) are still serious and still deserve care.

Just because a child doesn’t meet full diagnostic criteria doesn’t mean there’s nothing to worry about. Early patterns of restriction, preoccupation, or guilt around food rarely resolve on their own, and waiting often allows them to become more entrenched and carry over into adulthood (4).

4. What you’re noticing may only be the tip of the iceberg

Contrary to popular belief, eating disorders don’t like attention. It hides. It sneaks. It lies — even to the people who are most trusted. Many of my clients in recovery have shared how they went to great lengths to hide behaviours from those closest to them. And their parents tell me: “We had no idea all of this was happening.”

Not because they were being deceptive, but because of shame, fear, or the eating disorder voice convincing them to stay quiet.

It is therefore reasonable to suspect that whatever you’ve noticed, e.g. a skipped lunch, becoming vegetarian*, a sudden food rule, or an offhand comment about their body, may only be one small part of what is going on. There might be secret behaviours, deep distress, or rigid thinking that you haven’t yet seen.

This isn’t to scare you. It’s to honour the truth that your instincts matter, even if your child or friends downplay your concern.

*A note on vegetarian or vegan eating and Eating Disorders

Becoming vegetarian (or vegan) is increasingly common as children learn about the environmental, health and ethical impacts of food. This change on its own doesn’t mean an eating disorder.

However, without proper planning, removing entire food groups can make it harder for growing bodies to get the nutrition they need, and the reduction in calories can trigger disordered thoughts and behaviours in high-risk individuals. Sometimes, this shift can also be used, consciously or not,  as a socially acceptable way to restrict food or mask deeper distress around eating.

If your child wants to make this change, support their curiosity while ensuring meals remain balanced, adequate,  and regular. If you need to get support from a qualified health professional, like me, please do so.

5. Support is gentler and more effective earlier on

When we catch things early, support can be gentler, more collaborative, and almost always more effective.

Interventions are usually less intensive, less costly, and less disruptive to family life. There’s often less physical repair needed, fewer medical complications, and fewer entrenched beliefs to unlearn.

With the proper guidance, families can often make meaningful progress through early conversations, small practical changes, and coordinated care — long before crisis support is needed.

Even if things simply feel a bit wobbly around food and bodies, it’s worth talking about. It’s never the wrong time to start the conversation. Some great places to look for online information include:

• The Embrace Collective

• Butterfly Foundation

• Be Body Positive

• Be Real

5. It’s an opportunity to connect; even if they don’t want to hear it.

Your concern might be met with eye-rolls, frustration, or denial. 

That’s okay. 

Deep down, your child still wants to know that you’re paying attention. Many families tell me that, over time, these tough conversations opened up new levels of honesty, resilience, and connection. Not just around food, but in their relationship as a whole.

That is why how we approach these moments is very important. Below are some ideas to help you start that conversation with care and curiosity, building connection rather than breaking it.

What to Notice — Early Signs That Something’s Up

Disordered eating doesn’t always look like weight loss.

While weight loss, or insufficient weight gain or growth, is undoubtedly a red flag, it is not the only one. In fact, children and teens across the weight spectrum can experience serious medical and emotional consequences. It is estimated that less than 6% of people with an eating disorder are actually medically underweight (7).

Often, what parents first notice is subtle — a change in eating, behaviour, or language that doesn’t quite feel right. Below are some early signs that can be easy to overlook, especially when wrapped in the language of “health,” “clean eating,” or “performance.”

While every child is different, these are some of the early changes parents often notice before disordered eating becomes more visible:

• Dramatic shifts in food preferences, rules, or rituals

• Preoccupation with ingredients, labels, or “clean” eating

• Tracking food or calories (e.g. apps, watches)

• Guilt- or compensation-based language about food or exercise

• Change in appetite and now skipping meals or explaining hunger away

• Sneaking food or eating very large amounts of food in one sitting (often in secret)

• Growing rigidity or “all-or-nothing” thinking around food and movement

• Refusing rest days or training through illness or injury

• Steroid or performance-enhancing supplements

• Using diet pills, laxatives and enema misuse

• Body checking (often looking in the mirror) or body avoidance (baggy clothes, avoiding mirrors/reflections)

• Increased secrecy or defensiveness around food

• Change in personality, mood and social behaviours.

For a more detailed list of warning signs, look here.

A gentle reminder:

These signs don’t automatically mean an eating disorder — but they are enough reason to pause, observe, and get curious and reach out to a medical professional if needed.

Your child may not have the words to describe what they’re feeling, and they may not even realise something has shifted. Trust what you see. Early curiosity and care can make all the difference.

What to Do Next — Start the Conversation

As a dietitian with over 20 years of experience, this is how I approach conversations and care with clients across the eating-disorder spectrum.

I know, starting a conversation about eating, body image, or mental health can feel intimidating, especially when the young person or family is sensitive, defensive, or doesn’t see a problem. (I remember how nervous I was the first time).

But you don’t need to have all the answers to begin.

Keep your tone open and curious. You’re not trying to fix or accuse — you’re trying to understand. Even if the first conversation feels uncomfortable or is met with resistance, you’re planting an important seed: that their wellbeing matters.

Here is what i recommend:

1. Choose a calm moment

Avoid bringing it up in the middle of a meal or right after a conflict. Try a quiet, low-pressure setting, e.g. in the car, while walking the dog, or side by side doing something familiar.

Many children find it easier to open up when the conversation isn’t face-to-face.

With some teens, you might try giving them a bit more agency. For example:

“There’s something I’d like to chat with you about. When would be a good time for you?”

2. Lead with care, not confrontation

Start from a place of curiosity, not correction. Your goal is to open a door, not win an argument.

Instead of:

“Why aren’t you eating properly?”

Try:

“Hey, I’ve noticed a few things lately, and I just want to check in. Are you okay?”

Instead of:

“You need to stop talking about calories all the time.”

Try:

“I’m hearing a lot of worry about food lately. That sounds hard. Want to talk about it?”

3. Describe what you are observing

Describe what you’ve noticed in a calm, neutral way. Focus on observations rather than assumptions. This helps the young person feel seen, not judged.

When emotions are high, even the most caring question can sound like criticism. The goal isn’t to avoid the conversation, but to phrase them in a way that feels safe and curious, not blaming or shaming.

One of the simplest, most trusted ways to do this is to use “I” statements instead of “you” statements.

“You” statements often sound accusatory, even when they’re well-intentioned:

“You never eat properly.”

“You’re obsessed with calories.”

“You can’t eat that much junk.”

“I” statements shift the focus to your own observation and concern, which makes it easier for the other person to stay open rather than defensive:

“I’ve noticed you’ve been skipping meals lately, and I’m feeling a bit worried.”

“I’m hearing a lot of talk about food and calories, and I wonder if something’s been feeling harder lately.”

“I’ve recently noticed a lot of food wrappers in your room. You are not in trouble. I care about you, and I want to understand what’s going on.”

“I” statements communicate empathy and responsibility; they say I’m noticing, I care, and I want to understand, rather than you’re doing something wrong.

This small language shift can transform a tense moment into an opportunity for connection and trust, whether you’re a parent, counsellor, or health professional.

4. You can always come back to it

You don’t need to have the conversion all in one go and get all the answers at once.

Sometimes it’s simply about planting a seed and showing your child that the door is open whenever they’re ready. And then revisiting it again from time-to-time.

You might say:

“You don’t have to talk now, but I want you to know I’ll always listen. No pressure, no judgment. We can talk about it again later.”

5. Avoid weight or appearance talk

Even if you’re worried about body changes, focus on how your child feels, not how they look. This keeps the conversation centred on wellbeing rather than appearance.

Avoid:

“You’re losing weight."

“You’ve gotten bigger.”

Try:

“I’ve noticed you seem more withdrawn.”

“I’m wondering how your body is feeling these days.”

6. Be ready for resistance

It’s not uncommon for kids to get defensive or deny that anything is wrong. Stay calm, and don’t argue. Keep the door open with reassurance:

“I care about you, and I’m not going anywhere. If you ever do want to talk, I’ll be here.”

And remember, if the conversation brings up a lot of emotion, anger, or strong denial, that can be an even greater reason for concern. Often, the stronger the pushback, the more distress may be hiding beneath it.

You don’t have to figure this out alone.

Reach out to a trusted health professional, ideally a GP who listens without focusing on weight, or a dietitian experienced in eating disorders. They can help you assess what’s going on and guide your next steps.

It’s not about forcing a conversation. It’s about creating a sense of safety and showing your child that you’re paying attention.

It starts with one small step

You don’t need a diagnosis to ask for help, and seeking support doesn’t make you alarmist. It makes you proactive, caring, and deeply attuned to your child’s needs.

Early conversations can change trajectories. And sometimes, those first small steps, a talk, an appointment, a gentle check-in, are exactly what prevent something bigger from taking hold.

You don’t have to do this alone. If you’re worried, even just a little, talk to a qualified professional who understands child and adolescent nutrition and disordered eating.

I am also here to talk. We can work together to:

• Clarify whether what you’re seeing is part of a bigger pattern

• Explore simple, non-scary next steps

• Build a plan that supports your child’s wellbeing without shame or judgement.

Get in touch here.

References:

1. López-Gil, J. F., García-Hermoso, A., Smith, L., Firth, J., Trott, M., Mesas, A. E., Jiménez-López, E., Gutiérrez-Espinoza, H., Tárraga-López, P. J., & Victoria-Montesinos, D. (2023). Global Proportion of Disordered Eating in Children and Adolescents. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.5848

2. National Eating Disorders Collaboration (NEDC). https://nedc.com.au 

3. Academy for Eating Disorders (AED). https://www.aedweb.org/home 

4. Koreshe, E., Paxton, S., Miskovic-Wheatley, J. et al. Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 11, 38 (2023). https://doi.org/10.1186/s40337-023-00758-3

5. Austin A, Flynn M, Richards K, et al. Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. Eur Eat Disorders Rev. 2021; 29: 329–345. https://doi.org/10.1002/erv.2745

6. Hamilton A, Mitchison D, Basten C, Byrne S, Goldstein M, Hay P, Heruc G, Thornton C, Touyz S. Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders. Aust N Z J Psychiatry. 2022 Mar;56(3):248-259. doi: 10.1177/00048674211020102. Epub 2021 Jul 12. PMID: 34250844.

7. Flament, M. F., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H. N., Birmingham, M., & Goldfield, G. (2015). Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. Journal of the American Academy of Child and Adolescent Psychiatry, 54(5), 403–411.e2. https://doi.org/10.1016/j.jaac.2015.01.020

8. Levinson, C. A., Hunt, R. A., Christian, C., Williams, B. M., Keshishian, A. C., Vanzhula, I. A., & Ralph-Nearman, C. (2022). Longitudinal group and individual networks of eating disorder symptoms in individuals diagnosed with an eating disorder. Journal of Psychopathology and Clinical Science, 131(1), 58. doi:https://doi.org/10.1037/abn0000727 

9. Patton, G. C., Selzer, R., Coffey, C., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: Population based cohort study over 3 years. BMJ, 318(7186), 765–768. https://doi.org/10.1136/bmj.318.7186.765