Why can eating disorder recovery feel worse before it feels better? Learn why food anxiety, body image distress, and eating disorder thoughts may intensify during treatment—and what can help.

Many children have strong food preferences. They may refuse vegetables, eat the same foods repeatedly, dislike foods with certain textures, or hesitate to try anything unfamiliar. For many families, this is simply picky eating.

For others, however, food restriction becomes severe enough to interfere with nutrition, growth, physical health, emotional well-being, or everyday life. In these cases, Avoidant/Restrictive Food Intake Disorder (ARFID) may need to be considered.

Although picky eating and ARFID can look similar, they are not the same. Understanding the difference can help parents and individuals recognize when selective eating may require professional treatment.

Learn how virtual eating disorder treatment can help children, teens, young adults, and families access evidence-based care from home. Explore Ezer Psychotherapy’s interactive, family-centered approach.

Starting Family-Based Treatment while a child or teenager is attending school can feel overwhelming.

Parents may wonder:

• Who will supervise lunch?

• Will my child need to miss class?

• What should we tell the school?

• How can we manage therapy, medical appointments, meals, homework, and activities?

• Would it be easier to wait until summer?

Although treatment may disrupt familiar routines, an eating disorder should not be placed on hold for the school calendar. Early intervention matters, and delaying care can allow restrictive eating, bingeing, purging, compulsive exercise, and other eating disorder behaviors to become more established (Hornberger & Lane, 2021; Golden et al., 2022).

Family-Based Treatment, commonly called FBT, is an outpatient eating disorder treatment in which caregivers play an active role in helping their child recover. FBT has the strongest evidence base among outpatient psychological treatments for adolescents with anorexia nervosa and is also supported for adolescents with bulimia nervosa (Austin et al., 2024; Le Grange et al., 2015).

With a clear plan and appropriate support, families can often make FBT work during the academic year.

Sending a child back to school while they are receiving treatment for an eating disorder can create understandable anxiety. Parents may be concerned about missed meals, academic pressure, social comparisons, physical education, sports, bathroom access, and conversations about weight or dieting.

Although returning to a familiar routine can be beneficial, school should not interfere with medical stabilization, nutritional rehabilitation, or psychological treatment. A successful return requires an individualized plan developed with the child’s treatment team and school personnel.

When a child or adolescent is being treated for an eating disorder, few topics create as much anxiety as goal weight.

Parents may wonder:

• How is a goal weight determined?

• Why can’t treatment stop once vital signs improve?

• What if my child is already in a “normal” weight range?

• Why does my child seem more rigid or distressed during early recovery?

• Will clearer thinking return with nutrition and weight restoration?

These are important questions.

Weight restoration is not simply about reaching a number on a scale. It is the process of providing enough consistent nutrition to support the brain, heart, hormones, bones, growth, development, emotional regulation, and the ability to participate meaningfully in therapy.

When a child has avoidant/restrictive food intake disorder, commonly called ARFID, everyday meals can become a significant source of anxiety for the entire family.

Parents may spend hours planning meals, searching for foods their child will tolerate, preparing separate dishes, and worrying about whether their child is getting enough nutrition. Attempts to introduce a new food may lead to crying, gagging, panic, arguments, or complete refusal.

It is understandable for parents to feel frustrated, frightened, or unsure of what to do next. However, ARFID is not simply stubbornness, defiance, or ordinary picky eating. Children with ARFID may experience food as genuinely overwhelming, unpleasant, frightening, or physically uncomfortable.

Food exposures can be an important component of ARFID treatment. The goal is not to force a child to eat. Instead, exposure helps the child gradually build tolerance, flexibility, confidence, and new learning around food.

When someone with an eating disorder refuses treatment, families often feel frightened and powerless. Learn how to approach the conversation, identify urgent warning signs, avoid reinforcing the illness, and take practical steps toward professional support.

When someone with an eating disorder insists they are not sick, the response may reflect more than stubbornness or denial. Impaired insight—sometimes described as anosognosia—can affect how the brain interprets illness, body signals, and medical risk.

When someone you care about has psychogenic nonepileptic seizures, knowing how to respond can reduce fear, prevent injury, and support recovery. Learn what to do during an episode, what to avoid, and how to help without reinforcing disability.

Eating disorders and obsessive-compulsive disorder, commonly called OCD, are separate mental health conditions. However, they often overlap in ways that can make symptoms difficult for individuals, families, and even clinicians to distinguish.

A child, teenager, or young adult may become highly rigid about meals, repeat certain movements while eating, check nutrition labels excessively, avoid foods that feel contaminated, or experience intense distress when routines change. Some of these behaviors may be driven primarily by an eating disorder. Others may reflect OCD. In some cases, both conditions are present.

Understanding what is driving the behavior matters because eating disorders and OCD require specialized—but sometimes coordinated—treatment.

For many athletes, sport is more than exercise. It can be a source of identity, friendship, structure, confidence, and belonging. When an eating disorder requires an athlete to reduce or temporarily stop training, the loss can feel overwhelming.

Athletes and families often ask:

• When can I return to my sport?

• Do I have to be completely recovered first?

• How do we know whether exercise is medically safe?

• What if returning to practice triggers eating-disorder thoughts?

• Who should make the final decision?

There is no single timeline that applies to every athlete. Returning to sport after an eating disorder should be an individualized, gradual process based on medical stability, nutritional recovery, psychological readiness, injury risk, and the demands of the athlete’s specific sport.

The goal is not simply to get an athlete back into competition as quickly as possible. The goal is to help the athlete return in a way that protects long-term health, supports recovery, and allows sport to become sustainable again.

People recovering from an eating disorder sometimes notice something confusing: even after they begin eating more consistently, gaining weight may remain difficult or their rate of weight gain may slow.

This experience is often described as hypermetabolism—the idea that the body begins burning energy unusually quickly during refeeding. However, the scientific evidence is more nuanced.

Research consistently shows that metabolism changes during nutritional rehabilitation. Resting energy expenditure usually increases as the body emerges from starvation, repairs damaged tissues, restores organ function, and rebuilds lean body mass. A major 2024 review found that energy expenditure increased in most studies of people undergoing weight restoration, but generally returned toward an expected range rather than rising into a clearly hypermetabolic state (Reed et al., 2024).

In other words, increased nutritional needs during recovery are real. However, they may reflect a combination of normal metabolic recovery, physical repair, activity, incomplete intake, and individual variation—not necessarily a permanently “fast” or damaged metabolism.

Eating disorders can cause serious medical complications even when someone does not “look sick” or is not underweight. Adolescents and young adults with atypical anorexia, ARFID, bulimia, purging behaviors, or rapid weight loss may still experience bradycardia, orthostatic instability, electrolyte abnormalities, dehydration, delayed growth, menstrual changes, and cardiac risk (Society for Adolescent Health and Medicine [SAHM], 2022; NICE, 2020).

Medical monitoring is especially important when someone is beginning nutrition rehabilitation, increasing food intake, reducing purging, stopping laxatives or diuretics, or returning to activity. Recovery is not only about eating more; it is about restoring physical stability, growth, development, and overall functioning.

When a child develops an eating disorder, the entire family is affected—not just parents. Brothers and sisters often experience confusion, fear, frustration, guilt, and significant changes to everyday family life. For this reason, Family-Based Treatment (FBT), also known as the Maudsley Method, intentionally includes siblings whenever appropriate.

Many families wonder:

• "Why does my healthy child need to attend therapy?"

• "Will involving siblings make things worse?"

• "Shouldn't we protect them from all of this?"

These are understandable questions.

Research consistently demonstrates that eating disorders are family illnesses—not because families cause them, but because they impact every member of the household (Lock & Le Grange, 2015). Involving siblings thoughtfully can improve family communication, reduce fear and misunderstanding, strengthen recovery, and ensure that siblings themselves receive the support they deserve.

At Ezer Psychotherapy, we believe siblings should never become forgotten members of the recovery team.

Meal plans are not about dieting, punishment, or “perfect eating.” In eating disorder treatment, a meal plan is often used as a temporary recovery structure when hunger cues, fullness cues, food flexibility, and body trust have been disrupted.

For many people, the idea of a meal plan can feel scary. It may sound rigid or controlling. In reality, a recovery-focused meal plan is often designed to help someone eat enough, eat consistently, and eventually move toward food freedom.

Eating disorders can be difficult for parents to recognize. Many children, adolescents, and young adults do not directly say, “I need help.” Instead, parents may notice skipped meals, new food rules, increased anxiety around eating, excessive exercise, or a child who seems increasingly preoccupied with weight, body image, or “healthy” eating.

Eating disorders are serious mental and medical conditions that can affect physical health, emotional wellbeing, growth, development, and family life (Hornberger & Lane, 2021). They can occur across body sizes, genders, ages, and backgrounds, and a person does not need to appear underweight to be struggling (American Psychiatric Association, n.d.).

For many people, hearing that they need to temporarily stop exercising during eating disorder treatment can feel devastating.

Whether you're an athlete, someone who relies on movement to manage stress, or simply someone who enjoys staying active, being asked to stop exercising can feel confusing—or even unfair.

One of the most common questions we hear at Ezer Psychotherapy is:

"If exercise is healthy, why am I being told not to do it?"

The answer is surprisingly simple:

Exercise is healthy—but only when the body is healthy enough to benefit from it.

At Ezer Psychotherapy, the name itself tells the story of what I hope to offer every client. The word Ezer (pronounced ay-zer) comes from Hebrew and means help or strong support. I chose it because therapy isn’t about doing the work for you—it’s about walking alongside you with steady support, insight, and tools so you can build the resilience you need to thrive. My practice focuses on adolescents, young adults, and families, helping them fully function in life, even in the face of challenges like anxiety, stress, medical concerns, trauma, and performance pressures. Ezer reflects both the strength and the care at the heart of my work. Read more in this blog post.

The way we talk about food and bodies matters. Children and teens hear more than we think. Comments about weight, “good” and “bad” foods, dieting, or needing to “earn” dessert can shape how they feel about eating and about themselves.

A healthier goal is not perfect eating. It is helping kids feel safe, respected, and connected to their bodies.