Therapy Space With Dr. Sara: Tweens and Their Changing Bodies

My daughter is a “tween” and starting to talk more about how her body looks. She is now saying she needs to be on a diet. She actually only wanted to eat a few blueberries for breakfast the other morning because of this diet. I think she already eats healthy foods, she could probably get some more exercise though. I thought I would know how to manage this, encouraging her to be happy with who she is, but now that I am in the middle of it I don’t really know what to say.

This is such an important and expansive topic for discussion.  One study reports that “at age thirteen, 53% of American girls are ‘unhappy with their bodies.’ This grows to 78% by the time girls reach seventeen.” These are some staggering numbers! We also cannot overlook the numbers of boys that report feeling unhappy with the way they look. As there is a lot to consider, I have tried to condense my ideas and have attached links below for further exploration.

You don’t need to have the perfect response. 

Start by listening and getting curious. Jumping in with a well-intentioned message of support or advice may be premature. Find out where your daughter is getting her information from by asking questions. Did someone say something to her, is she comparing herself to images of other girls, is a friend starting a “diet?” This dialogue may provide you with information about why and how she is shaping her self-image and making decisions, like to start a “diet.” 

Identify values in this arena. If you have a co-parent, discuss this with him/her to ensure your child is receiving a consistent message. 

Convey the importance of overall physical and emotional health and well-being. Discuss with your child what a healthy lifestyle means. This brings the discussion away from the micro, like counting calories and blueberries, to the larger picture of daily decisions that impact her on all levels. A clear example you can share: a person may eat balanced meals every day and also chain smoke. Move away from the word “diet,” which provides little if any information, and towards “body-positive decisions” (or come up with your own term together). This approach applies to all body types. If your child is getting attention for being thin, which doesn’t necessary signify overall well-being, this doesn’t mean you can take a hands-off approach, nor should you. Talking about overall well-being is important for all kids, all sizes. 

Focus on attunement. 

What feels good for my body and what doesn’t? This self-exploration shifts the focus from looking outward for information (eg. a number on a scale or waiting for a compliment) to checking in with yourself. You can foster her awareness through teaching her to ask herself questions: How did I feel after I ate that? Did I have energy during practice? You can discuss body cues like a stomach ache, racing heart, sleepiness, etc. Staying attuned to one’s body cues allows for connection and a greater sense of inner control so your child can confidently say, for example, I know how my body feels when I sleep 9 hours versus 6 hours.

Filter the information coming in. 

We all receive constant input about ourselves from multiple sources. We know for children, peer feedback feels especially significant. You can normalize this for your daughter and empower her to ask herself, “Is this helpful information?” and “Is the source of the information someone I trust?” Use a cautious lens; examine the feedback further. For example, the pediatrician discussing her weight is different than a contact on social media, but it might not feel this way to your child. When you are young, maybe self-conscious, and trying to figure out how you fit into your environment, all messages may carry equivalent significance. Discuss with her how to slow down and vet the source. If the message doesn’t enhance her overall well-being, she doesn’t need to hold onto it. She has a choice. Also, a way to enhance empowerment is seeking out information from a trusted source. Before a pediatric visit, encourage your child to be curious and think of questions she can ask about herself and overall well-being, eg. what are some good breakfast options; what are the risks of teen dieting.

In addition, if your child is receiving compliments for her looks, pay attention. She should also be filtering the information and intentions. As her sense of self is developing, an association between worth and looks can develop. You can imagine what this will feel like as her body changes over the years.

Stay mindful of what you model for your kids: 

I recently spoke with a photographer here in Marin who stated that on almost all family shoots, the mother is critical of her looks and requests to be photoshopped. I am sure you can remember the overt messages you picked up on about weight, looks, aging, etc. during your childhood. In fact, I have had many female clients state they have religiously counted calories since they were very young, as a result of copying or joining their mother in this process. Speak kindly about yourself. If this is a struggle, it is important for you to pay attention to this and get the support you need as the relationship you have with our own body can carry over to your kids. Along this line, stay mindful of seemingly casual comments about others’ body weight, looks, or decisions. When you judge someone else, your child will believe you will use the same standard to judge him/her. 

Remember it is natural for children to ask questions and make comments about others as they try and make sense of their environment. This is a great opportunity to explore some of what I have already addressed. Example: “Mom, look at that person smoking over there.” Focus on the action, not the person. “People make different decisions. What have you learned about smoking and your body?

In addition, be aware of sudden behavior changes in your child. If there is a concern that your child is intermittently or chronically restricting food, binge-eating, avoiding eating out or with the family, experiencing marked social withdrawal, these can be signs of a deeper problem that could benefit from professional help.

Take home message:

As parents, we have ideal hopes for our children. We can feel so strongly about something, like wanting them to love themselves, but sometimes we can’t find words powerful enough to express this desire. You do not need to “fix” their body image and make them feel 100% comfortable. Rather you can create space to dialogue, share thoughts and experiences, reflect on what they see and hear around them, and foster empowerment. Focus on their overall well-being, whether this means eating, exercise, relationships, etc. Emphasize the importance of paying attention to their own cues and what to do with this information, fostering a mind-body connection. Again, they will receive an abundance of feedback and can learn to decide if the information is helpful or harmful.

Additional Information:

“Celebrating Every Body: 25 Body Image Positive Books for Mighty Girls.”,

Here are some great opportunities to explore body image with children. 

Niemtus, Zofia. “How to Teach ... Body Image.” The Guardian, Guardian News and Media, 20 June 2016,

Unrealistic body ideals are everywhere. Campaigns have been put into place to label Photoshopped images as such but clearly this isn’t the norm. Here are two shorts clips illustrating how the beauty standard is designed via Photoshop. 

“In the United States, 20 million women and 10 million men will suffer from an eating disorder at some point in their lives. Eating disorders are serious, life-threatening illnesses that affect all kinds of people, regardless of gender, ethnicity, size, age, or background. In fact, eating disorders have the highest mortality rate of any mental health concern. NEDA supports individuals and families affected by eating disorders, and serves as a catalyst for prevention, cures and access to quality care.”

“Our Work.” National Eating Disorders Association, 3 May 2018,