I write this as I'm about to give birth to my baby girl. I'm full of excitement and disbelief at how much I already love this tiny stranger poking my rib cage. But I'm also tormented by a deep-seated fear. I'm terrified that my daughter will inherit my eating disorder, that my own decades-long struggle with anorexia will ruin my child's life.
Of course, parents don't cause eating disorders. Although they used to be the main object of blame, increasing evidence suggests the real culprits are things such as altered neurological function, certain personality traits (including perfectionism, rigidity and tunnel-vision toward goals), and the way semi-starvation changes the brain. Parents have been exonerated, so much so that the Academy for Eating Disorders released a position paper firmly stating there is no evidence that certain parental attitudes or family patterns could be ''anorexogenic''.
But as someone with a 22-year history of anorexia, I'm quite sure I frequently say and do things that could negatively shape a child's ideas about food, weight and body image. This fear is not unfounded; a recent study showed that young girls who witnessed their mothers making negative comments about her weight, shape or diet were more likely to have lower body esteem and to exhibit restrictive eating behaviours. From my own experience, I know how even offhand parental comments can stick with us for a lifetime.
My parents were almost universally supportive and positive during my childhood, but a handful of times, they said or did things that set destructive gears turning in my head - and, decades later, those gears are still in motion.
Once, when I was 6 or 7, I remember my dad helping me button my jeans - my stubby little fingers lacked adequate dexterity - and he said, "You're getting pretty big for this." He meant, of course, I was getting a bit old to have my dad button my pants. I, however, interpreted it to mean I was literally too big, that my stomach was growing too monstrous to be contained by my L.E.I.'s.
After years of treatment centres, hospitals, relapses and recovery, I'm at a pretty stable place today. Most people who know me probably think my relationship to food and my body is perfectly normal - but that's largely because I can plan my days in such a way that my disordered behaviours remain hidden.
As she grows up, my baby will be with me at almost every moment, see everything I do, hear everything I say, and her little sponge-brain will absorb it all: She'll see how I always skip breakfast, how I restrict all day in anticipation of a large meal, how I prod and measure my flesh with my fingers.
These are things I would never want my daughter to emulate. So what can I - and other parents who struggle with food and body issues - do to prevent her from internalising my unhealthy outlook?
The first rule, according to experts, is both painfully obvious and incredibly difficult: For your kids to have healthy relationships with food and their bodies, you need to model similarly healthy relationships.
"Children pay less attention to what you say than what you do. Even if you attempt to hide these behaviours, children are extremely perceptive," says Dana Harron, a licensed clinical psychologist and author of the forthcoming Loving Someone With an Eating Disorder.
Howard Farkas, an instructor in psychiatry and behavioural sciences at Northwestern University's Feinberg School of Medicine, agrees. "We've evolved pretty well learning to eat by watching others, not by reading books about it," he says.
Children see and understand far more than we think they do, and these observations matter a great deal. This means parents should avoid restrictive or judgmental attitudes around food, never labeling items as "good" or "bad," which "can create a black-and-white way of thinking about food, which plays a big role in eating disorders," Farkas said.
It also, to the chagrin of those of us struggling with intransigent and deep-rooted diseases, means not just talking about food in a positive way, but eating it freely as well. This is particularly important because children copy parents' behaviours around food, and dieting is one of the primary risk factors of eating disorders (probably because the physiological effects of semi-starvation might trigger an eating disorder in a predisposed brain).
In other words, I can't just tell my little girl that choosing the fries is as valid as choosing the salad; I need to also eat some fries.
In that same vein, it's important to let food just be food, never using it as a reward or punishment, nor positioning it as something to be "earned." As someone who won't let herself eat until I've checked X things off my to-do list or done Y amount of exercise, this shift in mindset is a tall order for me; but I need to convey, as Harron put it, that "eating isn't about being good or bad, but giving your body the fuel it needs in as enjoyable a way as possible."
It's also essential to let your child be in charge, never judging or trying to control what they eat. Farkas explains that children eat intuitively for the first few years, but "self-doubt begins early with confusing eating rules. 'Don't ruin your appetite' may be interpreted as 'Don't eat when you're hungry.' These rules tell kids to ignore their instincts," he says.
Ariane Machín, a clinical and sports psychologist and co-founder of the Conscious Coaching Collective, has seen first hand how damaging adults' attempts to micromanage kids' eating can be: "One girl I worked with remembered her mom telling her she shouldn't take a second piece of cake, and took that as her mom calling her fat."
Adults, she says, frequently make comments that seem benign to them, but that loom large in the minds of impressionable children.
A better approach is to encourage your child to trust their own hunger signals and create opportunities to try a wide variety of foods without pushing anything on them. With Machín's own children, she grants "permission to the pantry," which means her kids feel free to have dessert before dinner and to snack when they're hungry. She's found that this leads to them self-regulate their intake, compared with a restrictive approach (No snacking before dinner! No sweets!) that can create "binge monsters."
Of course, food isn't the only albatross when it comes to eating disorders: There's also the body. It might seem obvious, but merits saying, that parents shouldn't comment on their child's shape or size. "Critical comments about body shape or weight, or even well-intended compliments, create self-consciousness about good versus bad bodies," Farkas said.
Parents also need to watch how they talk about the bodies of others and their own. People with eating disorders are often so entangled in their own body dysmorphic that they don't notice casual remarks they make about their shape and size. But kids notice, and these remarks teach them two damaging lessons that are very difficult to unlearn: that what matters most about a body is how it looks, and that there is an ideal body type toward which we should strive.
Parents can counteract this by emphasising the things that bodies can do, and normalising that we all come in different shapes and sizes. Or, better yet, shift the focus away from physicality entirely, praising kids for their kindness or humour, their excellent drawing skills, their formidable block-building prowess.
All this advice is helpful, if impossibly abstract to me at this point, just like the incomprehensible instruction sheet that came with our box of swaddles. To be a first-time parent is to walk blindfolded into a maze you must get through by feel, with unknown obstacles around unseen corners.
My anorexia - though I've known it so intimately for so many years - is one of these unknowns, manifesting in ways that I simply can't see because I'm too close: I don't notice when I push "dangerous" food to the other side of the table, how I check the calorie count of every food product I encounter. But, as I contemplate the imminent arrival of my daughter, I'm squinting my eyes and trying to see the outlines of the disease, to discern the adversaries I'll need to defeat to protect my baby girl.
And, just as I trust that I'll figure out how to use those swaddles, I must trust that I'll figure this one out.