When is it more than just “I don’t like my body”? What parents should know and look for as the school year begins.

The Perfect Storm. 

Cultural messages about how bodies should not only look but also function.  The hormonal stages of adolescents keep bodies changing quickly. Social media creating easy access to comparison in body types, clothes and seeing comments about bodies.  They are seeing clothing, workouts, before and after phots and narrow ideas of what it means to have a “right” body or even lifestyle. 

Now adding the beginning of the school year.  The pressures of sports, clubs, activities, school lunch, locker rooms and the social dynamics that comes with it all. 

So as a parent, how do you know when something is just normal development that is hard versus something that may be a bigger struggle that needs more attention and support? Especially when your child may not talk about it to you. 

A 2022 systematic review of 34 studies involving adolescents ages 10–19 found that 18% to 56.6% of adolescents reported dissatisfaction with their body weight, although rates varied considerably across studies. In some individual studies, rates were as high as 82.5% among boys and 83.8% among girls.

That tells us two important things.

First, body dissatisfaction is incredibly common among adolescents.

Second, this is not just a “girl problem.” Boys experience significant body dissatisfaction too, although what they are dissatisfied with—and how that dissatisfaction shows up—can sometimes look different.

We also know that body dissatisfaction exists alongside a significant amount of disordered eating. A 2023 JAMA Pediatrics systematic review and meta-analysis of 32 studies involving more than 63,000 children and adolescents across 16 countries found that approximately 22.4% screened positive for disordered eating using the SCOFF questionnaire. The rate was higher among girls (30%) than boys (17%). *Screening positive for disordered eating is not the same thing as having an eating disorder.

So what separates common body dissatisfaction from something that may need more attention?

1.        Look for patterns.

How often do you hear or see them expressing dissatisfaction with their appearance? Is it increasing more with time? Does “I don’t like how I look” turn into significant distress, anxiety, shame or even avoidance of things they would normally do.

2.        Is it changing their relationship with food?

Pay attention to changes in how, when, where and what they are eating.

Are they avoiding foods they used to eat? Skipping meals? Frequent bathroom trips after eating> Exercising more to cope with eating.

Changes can look “healthy” or even be stated as healthy (stay tuned for a blog coming soon about orthorexia). Do not pay attention to the label of food or routine. Be looking for how rigid are the rules and is food becoming fear, guilt or anxiety based.

3.        Is it changing how they function in their life?

Are they more withdrawn? Avoiding social events they used to participate in? Avoiding social activities that involves food or eating in front of others?

Do they wear only certain clothes? Oversized or long sleeves when it is hot out? Refusing to take pictures.

When body image is affecting what your teen does, it is worth paying attention to

Don’t just listen to what they say and look at their behavior. 

Not many teens will tell you or even their friends that they are struggling with how they look, how they feel in their body and how they are handling food.  It is hard to know when this is a moment for them to work through or when this needs more support.

I have spent much of my clinical career working with eating disorders across levels of care, from inpatient and PHP to IOP and outpatient treatment. That experience has taught me that these concerns don't always look the way we expect them to, especially early on. Every person can present differently.

Changes can be subtle.  They can look like typical teen behavior.  Sometimes, it doesn’t show up in behaviors you see fully with food. Sometimes it shows up in mood, anxiety, clothing, exercise or just how much mental space this takes up in their day to day.  Some of these things you can’t fully see as a parent. 

Below is a list of things to look for.  It’s not a check list.  It’s about stepping back and looking at this whole picture and how it comes together.  Do you see patterns, not just a few moments. 

Not Sure? You Don't Have to Figure It Out Alone.

If you're noticing changes in your teen's eating, body image, mood, or behavior, it's okay to reach out before you're sure there's a problem. With extensive eating disorder experience across levels of care, we can help you understand what you're seeing and determine what support may be helpful.

We also offer an Adolescent Body Image & Disordered Eating Group with a Parent Component, giving parents guidance on how to understand and respond to what their teen is experiencing while their teen participates in the group.

🍽️ Food & Eating

• Skipping meals or snacks

• Suddenly avoiding foods, they used to enjoy

• New or increasingly rigid food rules

• Becoming very focused on calories, ingredients, or “healthy” eating

• Anxiety or distress around eating

• Eating differently around others than they do at home

• Frequently talking about feeling “full,” “bad,” or guilty after eating

🪞 Body & Appearance

• Frequent mirror or body checking

• Repeatedly asking how they look or seeking reassurance

• Becoming very focused on a particular body part

• Comparing their body to friends or people online

• Suddenly avoiding certain clothes

• Becoming distressed about photographs or being seen

• Spending significantly more time thinking or talking about their appearance

🧠 Thoughts & Mental Space

• Constant comparison

• Preoccupation with weight, shape, or appearance

• Increasing fear of weight gain or body changes

• Black-and-white thinking about food (“good” vs. “bad”)

• Difficulty focusing on other things because of body or food concerns

• Increasing shame or self-criticism

🏃 Exercise & Movement

Especially important for teens involved in sports!

• Exercising much more than usual

• Feeling unable to take a rest day

• Exercising despite illness or injury

• Becoming distressed when exercise isn't possible

• Exercising to compensate for eating

• Increasing focus on exercise to change their body

👥 Friends & Social Life

• Avoiding meals with friends

• Turning down activities involving food

• Avoiding swimming, changing rooms, or other situations where their body may be visible

• Avoiding pictures

• Becoming more withdrawn

• Pulling away from activities they previously enjoyed

• Choosing activities based on how they think they will look or whether food will be involved

❤️ Mood & Behavior

• Increased anxiety or irritability

• More frequent emotional ups and downs

• Withdrawal

• Increased perfectionism or need for control

• Shame or embarrassment around eating or appearance

• Difficulty concentrating

• Changes in confidence or self-esteem

📱 Social Media & Comparison

• Increased comparison with influencers, friends, or peers

• Following accounts focused heavily on weight, fitness, dieting, or appearance

• Frequently commenting on other people's bodies

• Increased concern about how they look in posted photos

• Editing or repeatedly retaking pictures because of appearance concerns

• Changes in mood after scrolling social media

López-Gil, J. F., García-Hermoso, A., Smith, L., et al. (2023). Global proportion of disordered eating in children and adolescents: A systematic review and meta-analysis. JAMA Pediatrics, 177(4), 363–372.

San Martini, M. C., et al. (2022). Prevalence of body weight dissatisfaction among adolescents: A systematic review. Revista Paulista de Pediatria, 41.