Input needed: 14yo over-exercises, loss of period, Female Athlete Triad

[mother_sunshine]

Hi everyone, My daughter is going through some changes that I've been concerned about for the past few months. I'm not sure what else to do so I'm asking for your input.

She clearly has what is called "Female Athlete Triad" (http://kidshealth.org/teen/food_fitness/sports/triad.html if it's ok to link). She's lost about 20 lbs in 5 months, from around 115lbs to 95lbs (mildly underweight, very little body fat, she's 5'5") which doesn't concern me as much as the fact that she hasn't had her period since last October (5 months ago) as I'm sure the 2 go hand-in-hand.  We've had blood tests done to rule out any medical problems like anemia or leukemia...

A few months ago she started running about a mile every night.  This is in addition to surfing 2-5 hours per day, every day.  She refuses to take a day off from running, even after showing her that athletes take days off to prevent injury.  She only agreed to rest 2 weeks when she injured her foot from running.  She runs even when she's sick.

She does a long round of sit-ups every night.  She weighs herself every night and she looks at her body in the mirror often.  She's very happy with her appearance, but she seems to keep on trying to "improve".  This worries me and I've told her this. I've shared the link above with her also, and she listened, but she didn't ease up. 

She hasn't grown in at least 5 months. Actually she seems to have shrunk (she's an inch below the mark from 5mo ago) but I might have just measured wrong before (?). She wants to be tall so she can model...

A few months ago I shared with her that I used to have bulimia (I was a dancer) and all the detriment it did to my body...she said she thinks it's gross to throw-up...but I think I may have made a mistake by telling her.  Perhaps it triggered something in her?

Since she started running every night, she has refused to eat fast food and junk food.  This is actually a very good thing, I know, but she limits her intake of food in general.  She eats enough to not be too concerned, but she has changed her portions (and what she eats, more fruit and less carbs) quite a bit and, since this all happened around the same time, it adds to my concern that she may be verging on an eating disorder and/or hurting her body.  I know the loss of her period indicates lack of estrogen, but I also know that it is normal for a young teen to skip periods. She started her period early at 12yrs.

When I express my worries to her, she tells me not to worry and doesn't listen to my urgings to take a break and let her body heal.  I'm out of ideas.  I know it's not at the point of getting her psychological or medical help, but it may eventually come to that if she continues at this pace.  Any ideas on how to help her?  I don't want to make her feel controlled or overpowered.  I've always taught her that she is in charge of her own body.

[NewBeginnings1]

Kudos to you for being so aware of the changes in her. Has she expressed why she is running and doing sit ups? Did she set a goal that she is trying to achieve? Was it to loose weight or run a mile every night? She could be emulating the patterns of friends. The change in eating habits is worry some, but maybe it can also be an opportunity to teach her about good nutrition and healthy eating?

I actually think that it is at the point of psychological help. I say this because she probably hasn't started bulimia or anorexia habits, which means that you have an opportunity to prevent it. What if someone had intervened early in your case? You could tell her that you've made an appointment with a counselor to go over the news that you were bulimic and to just talk about it. Hopefully the therapist would be able to make a recommendation to you if she would need continual treatment, or at least they might be able to facilitate a healthy conversation about what she's going through.

Best of luck to you both,

[GoBecGo]

Does she run with a club?  I never have (because i'm TERRIBLE!) but i know a few girls in school did, and the coach was VERY quick to say it like it was.  For example i heard one male coach say to a very good athlete who was losing too much weight "i'm not interested in your teeny weeny bikini body, it's a machine and if you're not gonna maintain it right there's no place for you in the finals" (the upcoming races she was training for) and then he sent her to the sports psych the adult team used.  I don't know what happened ultimately but she did gain weight and keep running.  Just a thought - part of the problem can be that young athletes think "the doctor doesn't know about running" "mum doesn't understand the dedication you need for this sport", a coach can have more power in this area.

This is so hard, i want to congratulate you on being so aware of it all.  My mother would have had NO idea what weight i was, how much i exercised and certainly no idea about my periods!  In fact i know my sister, who it turned out had PCOS, told her at 16 "i haven't had a period in 5 months" and my mother said "if you're pregnant you can get out right now".  My sister was a virgin until she was 23 and her PCOS was undx until she was 38. :(  You're a great mama, this is a hard problem.  I'm thinking of you both.

[mtiger]

My daughter is an athlete, and much of what you post would concern me if it were my daughter.

For starters, though - I really wouldn't worry about the running that much. A mile a day is really not a lot. That is not going to do much to affect her physically. The 2-5 hours of surfing daily is much more strenuous than running a mile. Even the sit-ups added on aren't too huge an issue, IMO. The weight loss, daily weigh-in, inspection of her body and amenorrhea? Triggers a red flag for me. Any one of those, alone, might not be a big deal. My daughter's period stops when she's training particularly hard. Her doctor has said that it isn't something to be concerned about on it's own. If it were more prolonged or combined with some of the other things you mention? I'd be worried. Very worried.

The concerning part, for me, is her change in eating habits, her weight loss, and her apparent fixation on her body. An athlete needs fuel - a lot of it. The more active s/he is, the more fuel the body needs. Of ALL sorts. Yes, it's good that she's skipping junk food, but her body needs fruits & veggies, carbs, proteins. That she's losing weight tells me that she's not getting adequate nutrition - she should be at least maintaining weight. Even if she's losing fat (which you say she has none), she should be building muscle. If she has no fat and is still losing weight? Her body is using what it can find to sustain itself - most likely muscle. That's not good. 

To give you my point of context... As I said, my daughter is an athlete. She plays field hockey year-round, although there are breaks between seasons. She does some type of training daily. Depending on the team she's playing with, there may or may not be daily practices. When there are, she'll usually run a few miles in the morning, before heading off to school. Practice is intense, including running (distance and sprints), drills, scrimmages, etc. When there aren't daily practices, she also runs in the afternoon - she tries to put ~10 miles a day, split between morning and evening, although she'll do it all in one go if she skips a morning. And then she does drills on her own - working on speed, dribbling, taking shots, etc. And yes, sit-ups and push-ups.

Food-wise? She eats like a horse. For example, yesterday I sent with her to school: a bagel & cream cheese, a half box (dry) of cooked pasta w/butter (she takes a container of parm with her), a pint of strawberries, an apple with peanut butter, and two ham & cheese sandwiches (heavy on both ham and cheese). When she came home, she had another apple with cheddar cheese, some more strawberries (dipped in chocolate), and two glasses of milk. For dinner? One and a half full boneless chicken breasts, a portion of risotto, steamed veggies and sparkling water. A bowl of chocolate chip mint ice cream before bed. She's 5'6", weighs 115. There isn't an ounce of fat on her (okay - her butt LOL), and she's maintained her weight for several years. (She's 17, btw.) Given how active she is - that's not an outrageous amount of food. 

I would definitely be talking to her doctor ASAP. Also... is there someone she looks up to - a surfer, for example - who you could talk to and ask that they talk to her? And... I disagree that it's too early to look into psych or med help. 20 pounds in five months at her age? Is a lot! And if she won't listen to you, you need to find someone she will listen to.

[whatsnextmom]

I'd certainly keep an eye on it. My DD 14 is a dancer and a runner. The amount of activity you've mentioned isn't unusual for her but like the PP, my DD eats. The more activity, the more she eats. When she's not as active, she is not as hungry. We're vegetarians and fairly healthy eaters but she would never refuse french fries or ice cream. She's 5'6" and about 110. She only weighs in at doctor visits but her weight seems to stay steady whether it's track season or not.

I'd talk to her doctor first and see what they have to say. You've started noticing early so if there is an issue, I'm sure it can be turned around.

[mother_sunshine]

Thank you all for your input. It is much appreciated! You each gave lots of food for thought.

I talked with my husband (again) last night and he doesn't see a problem. He thinks she looks great, and he's happy that she's so active.  However, he is the one I continually have to "balance" with so I will continue to trust my instinct.  I'm grateful for your advice.  I will look into help for her.

[LuckyMommaToo]

I recently read the book Brave Girl Eating, and based on the story of the young teen in that memoir, your DD's habits definitely seem like red flags. I would really encourage you to read it if  possible. The woman (mom) who wrote the book also runs a blog, I believe. Here's the book:
http://www.amazon.com/Brave-Girl-Eating-Struggle-Anorexia/dp/0061725471

Here's an article excerpt of the book:

http://www-news.uchicago.edu/citations/06/061126.legrange-nyt.html

All the best to you and your DD.

-e

[Ldavis24]

Originally Posted by mtiger 

My daughter is an athlete, and much of what you post would concern me if it were my daughter.

For starters, though - I really wouldn't worry about the running that much. A mile a day is really not a lot. That is not going to do much to affect her physically. The 2-5 hours of surfing daily is much more strenuous than running a mile. Even the sit-ups added on aren't too huge an issue, IMO. The weight loss, daily weigh-in, inspection of her body and amenorrhea? Triggers a red flag for me. Any one of those, alone, might not be a big deal. My daughter's period stops when she's training particularly hard. Her doctor has said that it isn't something to be concerned about on it's own. If it were more prolonged or combined with some of the other things you mention? I'd be worried. Very worried.

The concerning part, for me, is her change in eating habits, her weight loss, and her apparent fixation on her body. An athlete needs fuel - a lot of it. The more active s/he is, the more fuel the body needs. Of ALL sorts. Yes, it's good that she's skipping junk food, but her body needs fruits & veggies, carbs, proteins. That she's losing weight tells me that she's not getting adequate nutrition - she should be at least maintaining weight. Even if she's losing fat (which you say she has none), she should be building muscle. If she has no fat and is still losing weight? Her body is using what it can find to sustain itself - most likely muscle. That's not good. 

To give you my point of context... As I said, my daughter is an athlete. She plays field hockey year-round, although there are breaks between seasons. She does some type of training daily. Depending on the team she's playing with, there may or may not be daily practices. When there are, she'll usually run a few miles in the morning, before heading off to school. Practice is intense, including running (distance and sprints), drills, scrimmages, etc. When there aren't daily practices, she also runs in the afternoon - she tries to put ~10 miles a day, split between morning and evening, although she'll do it all in one go if she skips a morning. And then she does drills on her own - working on speed, dribbling, taking shots, etc. And yes, sit-ups and push-ups.

Food-wise? She eats like a horse. For example, yesterday I sent with her to school: a bagel & cream cheese, a half box (dry) of cooked pasta w/butter (she takes a container of parm with her), a pint of strawberries, an apple with peanut butter, and two ham & cheese sandwiches (heavy on both ham and cheese). When she came home, she had another apple with cheddar cheese, some more strawberries (dipped in chocolate), and two glasses of milk. For dinner? One and a half full boneless chicken breasts, a portion of risotto, steamed veggies and sparkling water. A bowl of chocolate chip mint ice cream before bed. She's 5'6", weighs 115. There isn't an ounce of fat on her (okay - her butt LOL), and she's maintained her weight for several years. (She's 17, btw.) Given how active she is - that's not an outrageous amount of food. 

I would definitely be talking to her doctor ASAP. Also... is there someone she looks up to - a surfer, for example - who you could talk to and ask that they talk to her? And... I disagree that it's too early to look into psych or med help. 20 pounds in five months at her age? Is a lot! And if she won't listen to you, you need to find someone she will listen to.

All of this. I know from personal experience (I played intense field hockey too!) that when you exercise a lot a lot you tend to lose your period. I had lots of friends who were into gymnastics and running half marathons and actually the majority of them didn't have regular periods and they all said it was due to their very intense exercise...

Also as all the PPs pointed out when you are exercising that much you need to eat A LOT..I can't believe she has the energy to run and surf and all that while she is eating not much at all. her poor body is probably desperate for some carbs and major protein! 

Honestly, I would be freaking out if it were my kid, only because what you described is one red flag after another. It's like she is teetering on the edge of a knife, she could go down a very very dangerous dark path but if you help her and she lets you she might just be able to do things the healthy way. 

 Most of my friends and myself included on the field hockey team could have cared less what we weighed. We weren't weighing in every day or looking at ourselves in the mirror pinching fat here and there. We were way more interested in being able to run run run. We were doing 3 miles at the beginning of practice with sprints at the end, every single day. We didn't have time to care about how skinny we were, we all knew we were in good shape you know?

The mirror and weigh ins are the biggest issues with me, as well as limiting her overall food intake, those all sound like the verge of a major eating disorder.

[34me]

I have an athletic son with an eating disorder.  If your not worried about her having an eating disorder know, I would get her help now because I think it could easily head in that direction.  You could even start with someone non threatening like a registered dietician who could map out a healthy eating plan for her.

[CarrieMF]

Are there any trainers around she could talk to about nutrition?  AS stated the amount of physical activity isn't an issue.

5ft 5 & only 95lbs is more than slightly underweight.  IT alone can be a direct cause of the lack of period.

Not growing taller at 14yo & 5ft 5, she may have peaked or will grow a slight bit more.  I stopped growing taller when I was 11, I was 5ft 3 3/4.  When I was 13 I "shot up" 3/4" to get me to 5ft 4.5  I have a tall family, I just take over the recessive genes of the 2-3 short people in the family.

5ft 5 & only 95lbs is more than slightly underweight.  It alone can be a direct cause of the lack of period.

The weighing daily, body observations, wanting to look better does show she could be headed into eating disorder.  You believe the same. it wouldn't be a bad idea to get her to talk to someone who could help her with her athletic goals and still eat in a way to keep her body healthy.

[scottishmommy]

5'5" and 95 lbs would give your daughter a bmi of 15. That is very underweight. That coupled with fact that she lost almost 20% of her already light bodyweight is extremely concerning. I don't mean to be an alarmist, but I believe your daughter already has full blown anorexia nervosa. If I were you I would call her pediatrician for a referral to a good eating disorder psychologist. I'm so sorry you are going through this.

[redvlagrl]

Originally Posted by scottishmommy 

5'5" and 95 lbs would give your daughter a bmi of 15. That is very underweight. That coupled with fact that she lost almost 20% of her already light bodyweight is extremely concerning. I don't mean to be an alarmist, but I believe your daughter already has full blown anorexia nervosa. If I were you I would call her pediatrician for a referral to a good eating disorder psychologist. I'm so sorry you are going through this.

ITA.
 

You can look up "exercise anorexia". It sounds like she has anorexia with over-exercising.

[Mamabama]

Kudos for having an open relationship with your daughter and being aware of her body and behavior.  Under the "takes one to know one" law of recognition, I can tell you that your daughter is exhibiting several tale-tell signs of anorexia.  If she is not fully suffering from the disorder, she is two feet down a very short, slippery slope.  Please keep two very important things in mind: (1) anorexia is about CONTROL, not just a body issue - consider your daughter's behavior...she is trying to control her body through the foods she selectively eats and the obsessive amount of exercise she does and (2) people suffer from the disorder for entire life times and never admit it to themselves, let alone others that they are suffering from the disorder, so when you ask your daughter if she feels she has an eating disorder, or any version of that, she will not admit it to you or herself until she is really ready to seek help.  Please research your area for someone who specializes in eating disorders and have her evaluated.  And don't just go once.  One of the insidious parts of the disorder is the deception.  Sufferers become EXTREMELY adept at fooling everyone including themselves that they "don't have a problem."  I don't need to go into the irreversible damage that can be done, especially to a young body.  Not only that, but the controlling behavior she is exhibiting can escalate to other areas including drug and alcohol use to numb the anxiety accompanying the disorder.  Suffice it to say that the most loving thing you can do for your daughter right now is to seek help in as open, honest and as much as possible LEAST CONTROLLING MANNER because if she feels controlled by you she will balk and retreat from you.  You may want to seek help first from a professional to help you help her before making any moves.  Good luck.  I am sending you my strength.

[dreamchimes4]

hey :) I've been a lurker on mothering for a long while now, but this post really pushed me to speak for the first time. I hope that just because this is my first post I don't seem unreliable!

I danced (mainly ballet, but also jazz, tap, modern, flamenco, song and dance, etc.) since I was 2 1/2. It was a HUGE part of my life. By the time I was 13 I was clocking in hours upon hours a day training for dance competitions and recitals, plus I was the oldest (at that age!) in my school, so I was expected to be the "role model" for everyone. I never had trouble with eating, ate like a horse (as someone else said!), ate WHATEVER I wanted, etc. At 14 I gained a little weight (was still very thin) due to puberty, and it just set something off within me. What began as "I'm trying to get back to what I was, stop eating so much junk, be healthy, be the best I can be, etc." became full blown anorexia. I almost died, and my mom never did anything about it (at some points encouraging me) because she attributed my actions to dedication and even MATURITY (knowing what I want and doing anything I can do get it).

I am not at ALL comparing you to my mom...you sound like you are 100% dedicated to the health and happiness of your daughter. I'm so glad you are looking into her changes. I'm telling my story because

1) While I was very open with my mom about some things, I was very secretive about others...i.e. the obsession. She knew what I was eating, how active I was, what I weighed, etc...but she did NOT know the anguish and panic going on in my head. I was always happy and positive around her. Keep in mind that your DD may not seem "troubled" emotionally, but she very may well be hiding it inside.

2) I think it's so important that you find some sort of help...posters above gave a lot of great ideas. I particularly like the coach one (if the doctors and psychologists seem too scary at this point) because by the time my ballet teacher realized what was going on, she was a BIG part of my recovery and support. But--despite all the support from my ballet teacher, no one caught my ED in time, and by the point of change I was too weak to dance, and more importantly, TOO SCARED to dance. I loved (still love) dance, but can't get past my fear of it as a possible trigger. Also, my body has never been the same and I can't be active like I used to (as much as I want to). I have problems with weakness and fatigue, and my body still doesn't trust that I'm always going to feed it or nurture it like I should (and I've been recoverED for years and years now!)

It seems as though your daughter is so in to being active, and I would hate for her to lose that relationship with it...there are a lot of blogs out there (one of my favorites is www.ohsheglows.com) where women talk about fighting their EDs and developing healthy, happy relationships with food and excercise. I say that because sometimes it was hard for me to relate to someone person-to-person (it might be shameful for her?) and so getting to see people ONLINE who have overcome their issues and are now happy always gave me hope.

I recoverED on my own with online friends without doctors or psychologists because my mother refused to believe I had a problem (she wanted to be skinny like me). But I was INCREDIBLY LUCKY...to have had the determination, self-motivation, and found such a wonderful group of girls online to support me. But I wouldn't recommend that for anyone--it would have helped so much to have had an "intervention" from people who loved me and were close to me. I hope you can find a way to safely and respectfully give that to your DD. 

WISHING YOU SO MUCH LUCK...

note: she might be super resentful toward anything you do NOW...but will thank you for it later. whatever this is (ed or just on the way).

nicole

[mother_sunshine]

Update:

A few months ago my daughter read your posts because I thought it would be more valuable for her to hear your experiences and perspectives than to take her to a psychiatrist (we live in a small town with limited resources, no experts on eating disorders here). I think you all gave her some valuable food for thought and I appreciate it!

She now weighs around 110lbs, so she is at a healthier weight. She hasn't grown, she's still 5'5". She still doesn't eat large portions, like a full meal, but she snacks much more often.  She snacks quite a bit, actually, and often hides it (which is fine with me, albeit strange, as long as she's eating).  I've come to the point of having lots of healthy snacks available (fruit, nuts, crackers, veggies, hummus, yogurt, granola, etc.), and I know when she eats them because she leaves the lids off, packages open, or a trail of debris on the cabinets and floor.  She still isn't eating enough protein, dairy, and grains/carbs.  She won't eat meat, and she eats less and less cheese and bread products. She says she is allergic to dairy and wheat, they make her stomach hurt, although she regularly "sneaks" ice cream and yogurt with no apparent problems. I'm getting more creative with grains, often cooking leftover quantities of quinoa, wild rice, oat muffins, tamales, etc., to give her plenty of alternatives to choose from. She is keeping me on my toes.

She still exercises the same amount except she takes one day off each week. She says she needs it as stress-relief. She's a high-achiever in school, involved in student government, etc. I know she deals with a lot of pressure so I'm glad she has the outlets of running and surfing.

The only problem, still, is that she hasn't had her period since last October. That tells me something is still wrong. Her doctor says it's normal for girls who exercise a lot....which I understand. But how long is normal? Will it harm her body permanently?

[McGucks]

OP, I am really afraid your daughter truly does have an eating disorder or is, as another poster said, on a very fine line with it.  Her hiding food and claiming allergies are two behaviors, in addition to the many others in your original post, that are of great concern.

I had an eating disorder for about two decades and way too much of your daughter's behavior sounds awfully familiar.

Eating disorders are notoriously hard to treat, and I understand that your town is not one with doctors who are competent in treatment.  I wish you and your daughter much luck and love, and I sure hope I am wrong about what seems to be going on.

[FarmerBeth]

Originally Posted by mother_sunshine 

Update:

A few months ago my daughter read your posts because I thought it would be more valuable for her to hear your experiences and perspectives than to take her to a psychiatrist (we live in a small town with limited resources, no experts on eating disorders here). I think you all gave her some valuable food for thought and I appreciate it!

She now weighs around 110lbs, so she is at a healthier weight. She hasn't grown, she's still 5'5". She still doesn't eat large portions, like a full meal, but she snacks much more often.  She snacks quite a bit, actually, and often hides it (which is fine with me, albeit strange, as long as she's eating).  I've come to the point of having lots of healthy snacks available (fruit, nuts, crackers, veggies, hummus, yogurt, granola, etc.), and I know when she eats them because she leaves the lids off, packages open, or a trail of debris on the cabinets and floor.  She still isn't eating enough protein, dairy, and grains/carbs.  She won't eat meat, and she eats less and less cheese and bread products. She says she is allergic to dairy and wheat, they make her stomach hurt, although she regularly "sneaks" ice cream and yogurt with no apparent problems. I'm getting more creative with grains, often cooking leftover quantities of quinoa, wild rice, oat muffins, tamales, etc., to give her plenty of alternatives to choose from. She is keeping me on my toes.

She still exercises the same amount except she takes one day off each week. She says she needs it as stress-relief. She's a high-achiever in school, involved in student government, etc. I know she deals with a lot of pressure so I'm glad she has the outlets of running and surfing.

The only problem, still, is that she hasn't had her period since last October. That tells me something is still wrong. Her doctor says it's normal for girls who exercise a lot....which I understand. But how long is normal? Will it harm her body permanently?

Your earlier posts sound very much like me as a young athlete (track and field and gymnastics).  I don't think you should worry as much about the growing (many girls stop growing after their periods start) or even at the weight.  I also think her level of exercise is not unreasonable (went to school with 2 international class paddlers who exercised more than this and they and their periods were just fine).  I think what matters the most is her state of mind.  I'm seeing that she is an overall high achiever, and her eating related problems seem to be very much about being obsessed with perfection.  I can remember being a teenager and not only counting calories but nutrients and trying to create the "perfect" diet.  I didn't have weight related body image issues like your daughter (did wish for a bust!) but I did have a problem with being less than "perfect", in sports, school, music, and even with hobbies that should have been for relaxing.  If you think that's at all your daughter, I think you should do whatever you can to help her feel comfortable finding someone to talk to, preferably a counselor.  I chose to get help as an older teenager, and it was one of the best things I did.  I really needed help from someone else to gain clarity about my own thoughts and how they were affecting my happiness. 

Physically speaking, if she won't eat meats, you could suggest calorie and nutrient dense nuts, and hype up their metabolism balancing and energy giving benefits.  All our family have high metabolisms and are very active, and I don't know what we'd do with a handful of nuts a few times a day to give energy.  And I wanted to give you hope that I had lost my periods over a year as had several of my team mates.  We were all able to be healthy and to have children when we were older, etc.  I think now that your daughter is starting to gain weight (I'd say still underweight for an athlete because of the muscle mass, but way better than the previous 95 lbs, a 15 lb weight gain is really pretty good), if she is encouraged to continue nurturing her body (maybe even take advantage of perfectionist tendencies a bit and remind her of how much fuel is needed to maintain muscle mass and energy), the primary concern is still dealing with how she's doing emotionally.  Fis the thought pattern, and better eating patterns will follow.
 

[ameliabedelia]

It's good that she's gained some weight, but I definitely think your daughter needs a lot of support and perhaps professional help.  I do think she either has an eating disorder or disordered eating.  The sneaking food is a huge red flag.  Eating disorders are more about control than about weight.  Plus, it is very common for anorexics to sometimes have bulemic or binge-eating behaviors..  It doesn't sound like your daughter is really binging in the true sense the way we think of a binging, but in *her* mind, if she feels like she can't control the eating it could be somewhat of a "binge" even if it's just a moderate amount of healthy food and not a huge amount of junk food.   The fact that she is sneaking food (which I assume is available to her freely...you don't limit it) shows that she doesn't really have a healthy attitude towards food.

Someone could have an eating disorder and still be a "healthy" weight...although 110 for 5'5" is underweight or on the very low end of "normal".   Menstruation is more about body fat percentage than about weight.  If a women's body fat percentage is too low, she won't menstruate.  She is very athletic and probably has a lot of muscle, but little body fat why is why she isn't having periods.

[mother_sunshine]

Thank you for your supportive and helpful responses.

I've gone through this thread again for more ideas (and will continue to do so). We watched the video on the Maudsley Approach http://www.maudsleyparents.org/ and it all fits what she's going through.  I had her watch it this morning and she said nothing, no anger or anything negative, and she seems willing enough at the prospect of letting me help her overcome the eating disorder. I know it's helping to have plenty of her favorite food options in the house for her to snack freely....It's a start.  Now I just need to be more watchful of her meals.   It helps a lot to see this as a problem separate of herself that we need to conquer together. I've ordered Brave Girl Eating and am hoping to gain more tools needed to help her through this.