According to the National Eating Disorders Association, around 30 million Americans, or 9% of the U.S. population, struggle with an eating disorder during their lifetimes. From 2018 to 2022, health care visits for eating disorders among individuals under 17 years old increased by 107.4% in the U.S., rising from approximately 50,000 visits to more than 100,000, as reported by The Journal of Pediatrics.

Dr. Tara Arnold, founder and Clinical Director of Deepen Wellness and Psychotherapy, explained that the COVID-19 pandemic was a key driver behind the increase.

“Over the last decades, the ages of people developing eating disorders has gotten lower and lower, and inpatient eating disorder treatment centers have been created for younger and younger ages as our culture becomes more and more superficially motivated and the need for acceptance and connection increases,” Arnold said. “There is an epidemic of loneliness post-pandemic. The disconnection created by the Internet and social media, and the many ways that people do not truly connect, make us vulnerable to eating disorders.”

According to the National Library of Medicine, 7.8% of the general population experienced an eating disorder in 2022; in the same time frame, that prevalence was 22.3% among children and adolescents. This trend is especially prevalent in youth girls, with the National Institute of Mental Health reporting that eating disorders occur more than twice as often in adolescent females as in adolescent males.

“Adolescence is a vulnerable time for the development of eating disorders because, developmentally, we are in a very open and impressionable space,” Arnold said. “We are eager to understand the world and ourselves, and so we look to media and social media, our families, our culture and more.”

As discussions about wellness and appearance continue to increase on social media, the line between “healthy habits” and harmful behaviors has become increasingly blurred. Midtown student Allison Briggs*, who suffers from an eating disorder, believes this pattern has contributed to a growing division between the lived experience of an eating disorder and how it is publicly portrayed. 

“The actions of the eating disorders — things like restricting how much you’re eating, over-exercising, counting calories and all of the symptoms — are glamorized, but then the eating disorder itself isn’t,” Briggs said. “People will praise women when they don’t eat, but then you can’t say that you have an eating disorder, especially in the media and with people who have a lot of popularity. I think that people glamorize the actions, but then they don’t really give it the accountability of saying that this is unhealthy, and this isn’t okay, and it is an eating disorder.”

While disordered eating has been a struggle for junior Lilo Cassimatis throughout her life, she said it really became a serious issue in eighth grade.

“Since I was really little, I have always noticed how much food I eat, and I have been self-conscious about it,” Cassimatis said. “I really started counting calories in January of my eighth-grade year, and it got worse and worse over time, and by May, I was hospitalized.”

Briggs’ disordered eating followed a similar progression.

“My relationship with food changed, and it definitely got worse as I got older,” Briggs said. “I think that the transition from middle school to high school was the worst. Everyone’s getting older. These pressures don’t just start and stay; they kind of grow and evolve, so I think that they just kind of got worse, and the weight got heavier throughout time.”

Girls who are teased about their weight are more likely to use extreme measures of weight control. Midtown student Piper Smith* said she experienced this firsthand, receiving criticism from her peers about her body, which gradually made her more self-conscious about her appearance. 

“It all started for me in fifth grade,” Smith said. “I used to be a little bit bigger, and in fifth grade, the guys would call me fat all the time. That was just the main thing I got, just fat jokes as a little elementary schooler. It made me start thinking about myself in a bad way. Since it started so early and then continued through middle school, I just, over time, developed a really bad body issue.”

During puberty, the body undergoes a range of physiological, environmental and psychological changes. While everyone experiences this change, adolescent girls are more prone to the negative consequences of puberty, including greater body dissatisfaction. Arnold described an aspect of puberty that helps explain this trend.

“Once we hit puberty, there is a phenomenon known as the ‘desirability’ shift,” Arnold said. “This desirability shift makes us go from being more comfortable with our individual uniqueness to being more attuned to the way the gender that we are attracted to sees us, what they find attractive. Then we try to move ourselves, our behavior, our appearance, our ways of being towards what we think is the more ‘attractive or alluring’ way to be. This is not an all-or-nothing time, but a time that we begin to tune into a different part of the world and how we fit into it.”

Cassimatis said her disordered eating started with a New Year’s resolution to give up sugar, but she took it too far.

“For example, once, we went on vacation out of the country, and I wouldn’t eat sugar,” Cassimatis said. “I lost a ton of weight because after I started limiting sugar, I got into how much protein and how many calories, and it just kept getting worse and worse and worse. Eventually, I just became scared of all food and all calories, so I just wouldn’t eat enough at all.” 

Briggs said her eating disorder also started with minor changes, but she quickly fell deeper into a problematic relationship with food.

“I think it started as, ‘Oh, I’m not gonna eat as much because I don’t like the way I look,’” Briggs said. “Then, it evolved over time into something worse. That’s also where it gets dangerous because you might not see how bad it’s getting until you’re looking at it behind you.”

Girls begin worrying about their weight as early as ages 6 to 10, and the National Association of Anorexia Nervosa and Association Disorders found that by 14, about 60% to 70% are actively trying to lose weight. Arnold said this trend reflects the broader “skinny culture” in the U.S., which she sees as a major driving force behind these concerns.

“Our culture in America and in Atlanta dictates our concept of beauty and can make unattainable standards of beauty seem very important, and can make us feel unacceptable if we do not exactly fit the mold,” Arnold said. “This was all happening even before social media. Add to this pressure the global pressures of access to tons of different ideas of beauty and unrealistic images of perfection, and we have a recipe for people to do very unhealthy and self-destructive things to try to be attractive, accepted, loved, desired, popular or what they find important.”

According to the National Eating Disorders Association, in the U.S., 69% to 84% of women experience dissatisfaction with their bodies, a figure often linked to the growing prominence of the “thin ideal” in the media. Cassimatis said the ideology surrounding “skinny culture” has become too normalized.

“I never thought my problem was isolating, but I think it’s pretty sad to know that so many girls feel so pressured that they end up developing eating disorders,” Cassimatis said. “It’s a pretty normal thing in today’s society, so that doesn’t surprise me that the numbers are so high.”

Arnold agreed, adding that eating disorders can extend beyond restrictive eating. 

“Culturally, we hear a lot of messages about beauty — the size of butts, breasts, hips, stomach, etc.,” Arnold said. “Bigorexia is also a concern where people who want to be seen as strong and muscular can never feel like they are ‘big’ enough or muscular enough. The preferences of our specific culture will influence us the most.” 

Beyond cultural standards, Cassimatis cited athletic pressures as a major driving force for her disordered eating. Growing up as a dancer, she was often told that being skinny made her look “prettier” when she danced.

“When I first started losing weight, and it became noticeable, a couple of my dance teachers made comments,” Cassimatis said. “They were like, ‘Wow, good job losing weight,’ or ‘I can tell you’re keeping the pounds off.’ I kind of internalized what they were saying, and it made me happy at the time, but looking back now, I don’t think that was a good thing for them to say.”

Briggs also plays a sport and faced similar pressures as Cassimatis. 

“Growing up, for me, there was a lot of pressure in sports, which was a big part of it,” Briggs said. “I know a lot of people started gymnastics when they were young, and I’ve talked to other girls who felt that that was a negative experience for their body image later on in terms of having to look a certain way.”

Humans have a natural desire to fit in, shaped by the evolutionary need to belong for survival. This fundamental tendency is tied to the desire to please others. Arnold believes this desire is strongly correlated with body image.

“Body image is impacted by everyone that we look up to — parents, family members, siblings, teachers, doctors, coaches, principals, etc.,” Arnold said. “Now, add to the global influence of influencers, movie stars and models. These people that we look up to are also human, so they have their own imperfections, and they also live in diet culture, along with the rest of us. They can have their own body image struggles, body shame and self-esteem struggles.”

Smith emphasized the importance of maintaining a balanced relationship between mental and physical well-being by setting goals that are both realistic and healthy. 

“Everyone’s body is different, and you should never compare your body to anyone but yourself,” Smith said. “It is fine to have healthy goals for your body, such as ‘I want to gain 10 pounds of muscle,’ or ‘I want to drink more water,’ but don’t make extremely unrealistic goals.”

The human body relies on calories and nutrients from food to produce energy and maintain vital functions. When Briggs began to severely restrict her food intake, everything became harder.

“People need to realize how much having an eating disorder takes away from your life,” Briggs said. “You can’t do anything if you don’t eat. When you don’t eat, you can’t think straight. Your body doesn’t move the way you want it to, and you can’t enjoy experiences that make life so amazing when you are limiting one of the key functions that are keeping you alive.”

“Fad diets,” eating plans marketed as fast ways to lose weight, can cause weight gain. Restrictive eating triggers metabolic slowing, and when food intake returns to normal, it is easier to gain weight.

“Diet culture is a multi-billion-dollar industry, and they do not make money if diets work, so they craft these images and diet plans that are not realistic for the long term or sustainable to keep themselves employed,” Arnold said. “Most diets are very restrictive, and they then create an overindulgent response when the diet is over. Then we do the notorious yo-yo dieting, which is what changes our metabolism and creates long-term weight gain and less health for our bodies as the genetic blueprint is overridden.”

Briggs felt the negative health effects in both school and her sport.

“For me, I wasn’t eating,” Briggs said. “I wasn’t eating breakfast. I wasn’t eating lunch. I wasn’t really eating dinner. I was pushing myself athletically and academically, but it was still never the place that I wanted it to be because I wasn’t eating. I wasn’t doing as well in school as I wanted to. I wasn’t performing in my sport. That was just so detrimental: the combination of pushing myself so hard just to have it come back and have the opposite effect.”

The Harvard T.H. Chan School of Public Health reported that eating disorders have the second-highest mortality rate of any psychiatric illness, and every 52 minutes, a life is lost as a direct consequence of an eating disorder. Cassimatis said she was scared to join that statistic.

“I had a really low heart rate, and I started having to sit in my bed at night with a pulse oximeter, and my dad would sit with me, and it would be in the 30s,” Cassimatis said. “I was just so scared I was going to die because it was so low. That was the main thing that scared me because I obviously didn’t want to die, but I also didn’t want to have to change the way I looked.”

Cassimatis’s eating disorder did not just impact her own health. The people around her, including her mother, Sudie Nolan-Cassimatis, noticed as her weight began to plummet.

“There were some actual physical symptoms, and she began to become quite emaciated,” Nolan-Cassimatis said. “She started looking skeletal, which is harder to notice sometimes because at various ages we aren’t around our kids when they are not wearing clothes, but for a while in the early stages of Lilo’s eating disorder, she still really liked looking that way.”

As Cassimatis’ body began to change, her clothing size decreased, but so did her ability to dance, as she was forced to quit dancing for eight months.

“Lilo was dancing, and she started to restrict what she would eat, and then she would exercise a whole lot,” Nolan-Cassimatis said. “Actually, she started to lose a lot of weight, so much so that we had to go shopping for clothes that were like two sizes smaller than what she had worn. Sometimes, she would try things, on and nothing would fit, and we started to become very concerned. She then started to have pain at dance and started to not be able to dance because she was having pain.”

Smith’s disorder extended beyond food avoidance. She developed bulimia nervosa, an eating disorder characterized by repeated episodes of attempts to purge or induce vomiting to prevent weight gain.

“About halfway through freshman year, I started making myself throw up,” Smith said. It started as a way to stay skinny, but I got so used to it, and it just became so normal for me.”

Smith explained that purging evolved from a focus on weight to a broader emotional release.

“The throwing up sort of became an outlet for me,” Smith said. “Whenever I was super overwhelmed, I would make myself throw up almost as a way to escape from my troubles. I had all of this anger and emotion, and I didn’t know what to do with it, so I would just use throwing up as an outlet. I would go full weeks without eating, and I was throwing up for both food problems and as an outlet for my emotions.”

Only about one-third of people with eating disorders receive treatment, as reported by the Alliance for Eating Disorders Awareness. Arnold stressed the importance of starting recovery, specifically relying on experts for care.

“Starting with an eating disorder therapist is the first step to assess the severity and create a plan for recovery for adolescents and teens, as well as adults,” Arnold said. “Eating disorders are dangerous and deadly, so having an expert is highly important — more so than most other mental health concerns, as eating disorders are in the top two most deadly mental health disorders.”

While professional support is essential in recovery, personal relationships can play an equally critical role in recognizing the problem and encouraging someone to seek help.  

“The way that my family all found out was from my friends telling them,” Briggs said. “I think having those people around me, they didn’t just notice, but also went and did something about it to make sure that I could get to a healthy place because they saw that I wasn’t in one, was important. From there, it went more onto my parents and my family to support me through the recovery process.”

The National Library of Medicine reported that more than 70% of people with an eating disorder suffer from another mental, emotional or behavioral health disorder. Arnold explained how this impacts eating disorder treatment strategies.

“Treatment involves learning to face our feelings and our emotional needs in nurturing ways and connecting with others, rather than turning to food to cope,” Arnold said. “Oftentimes, we turn to food for things only relationships with others can solve, like loneliness, sadness, disconnection and anxiety, so learning to feel our feelings and reconnect to others who are healthy is the key to healing.”

Looking back, Nolan-Cassimatis said she wishes she had recognized earlier how some of her daughter’s behaviors signaled deeper concerns.

“There were times when she would not eat something or substitute something else,” Nolan-Cassimatis said. “Sometimes, it was hard to know because if she said, ‘I’m not hungry right now,’ we sometimes just took that at face value. However, I do think those were warning signs, and then I think there were also probably warning signs that we just totally missed. I think that sometimes being crossed over with teenage years can make some of those signs difficult to recognize.”

Arnold noted that when symptoms become severe, higher levels of care may be necessary.

“If the eating disorder is severe enough to warrant inpatient treatment to get physical health back on track, then in Atlanta, places like CHOA (Children’s Healthcare of Atlanta) are the first stop to get labs and food intake stabilized,” Arnold said. “Then, they can usually help us find inpatient treatment and outpatient treatment at Clementine, the Emily Program, Renfrew or online programs.”

Briggs said the journey of recovery can be long and grueling. She said fully eliminating the disorder requires a sustained, consistent willingness to challenge the patterns that contributed to its persistence.

“I know a lot of people say that they feel recovered, but I just don’t feel like I ever fully got to a place where I am 100% recovered,” Briggs said. “It’s been a really long process, and I have grown so much, and I’m not in the place that I was. At the same time, an eating disorder can be such a big part of your life that it’s really hard to get rid of completely. Continuing over time to keep fighting and keep doing what you know is right and what you know is best for you is always the right choice and has changed my life in so many ways.”

Even so, Briggs emphasized the importance of establishing a healthy environment for young girls. She said that fostering positive messages and ideologies can help counter the pressures that often contribute to disordered eating.  

“One idea that I was raised on was that the way you look is the least important thing about you, which I think is something that does need to be repeated to young girls over and over again, especially since they’re constantly being told the opposite,” Briggs said.

As body dissatisfaction rises among teens nationwide, Cassimatis remembers the moment her own struggle intensified. What had once been background noise became constant pressure shaped by the expectations surrounding girls her age. 

“As long as I can remember, I just felt like there was pressure to be skinny,” Cassimatis said. “In eighth grade, my problem became serious after I cut what I was eating by an insane amount. I lost so much weight in a quick amount of time.”

Cassimatis said the weight loss quickly took a toll on her health, drawing concern from her parents as the changes became more visible. 

“My parents first started to realize it was a problem when I lost a ton of weight, and you could see it,” Cassimatis said. “But simultaneously, I had no energy and lost all of my personality. There was this one day at dance where I had no energy, and we were literally doing our warm-up stuff on the bar, and I started crying because I just couldn’t do it. I had to go home and after that my parents really started to get concerned.”

Soon after, Cassimatis was connected with a specialist in disordered eating and placed in a partial hospitalization program to begin treatment. But at a routine appointment before her start date, her vital signs raised immediate concern. She was admitted to the emergency room, where she stayed for a week to stabilize her vitals. 

“I went to the ER, and they admitted me and had me stay at the hospital for about a week to stabilize my vitals and put me on a meal plan,” Cassimatis said. “It was a really low one because I just had to start eating a little bit. If I didn’t eat the food, then they would tube me, so I forced myself to eat it because I didn’t want to get tubed.”

Cassimatis was then admitted to a residential treatment facility, where she lived for over a month under continuous monitoring and strict guidelines. After completing the full-time program, she continued treatment on a daily basis, attending sessions after school before eventually transitioning to an online format. However, Cassimatis said that despite progressing through each stage of treatment, she didn’t actually want to get better. 

“I started sneakily throwing food away and flushing it down the toilet, just not eating it because I didn’t want to gain weight,” Cassimatis said. “My vitals started going back downhill again, and I had to be fully readmitted into the residential program.”

After undergoing treatment for more than a year, Cassimatis said she began to notice a shift in how she approached recovery. She said the mental component ultimately played a central role in her progress.

“I don’t know what happened, but it just kind of clicked, and I decided I wanted to get better,” Cassimatis said. “The treatment can definitely help you to an extent, but in the end, it’s really your decision. You don’t have full control over your mind, as it can just get caught up in a lot of stuff, but ultimately, you just have to realize that gaining weight isn’t the worst thing in the world. I started to see it from a different perspective, and I slowly was able to get better by myself.”

Since recovering, Cassimatis has been able to return to a sense of normalcy. Looking back, she said she wishes she had understood earlier how deeply appearance-driven pressure can distort a person’s sense of worth.

“I’ve come to realize that even if I don’t eat because I don’t like how I look, it’s not going to just magically fix all of my problems,” Cassimatis said. “I totally understand if you want to look a certain way and have a certain body, because to a certain extent, that is normal. I just think young girls need to know that you shouldn’t be sacrificing your body by doing anything unhealthy to get there.”