Fiona Yassin, eating disorder specialist, family psychotherapist, and founder and clinical director of The Wave Clinic, discusses the family wellness trap.
In many aspects, eating disorder services have made significant progress in more recent years. We understand far more about the biological, psychological and social drivers of these illnesses now than ever before. And yet, many young people continue to cycle repeatedly through services, and relapse rates remain stubbornly high.
Perhaps, therefore, the question we should be asking does not centre on why an individual has failed treatment, but whether the treatment itself is failing to evolve alongside the world young people return to.
Eating disorders have historically been conceptualised as conditions residing within the individual. And treatment pathways have reflected this, focusing primarily on symptom reduction and weight restoration, while family involvement has often remained secondary. More often than not, the patient remains the primary target of intervention.
But this approach increasingly feels out of step with today’s contemporary family life. Over the past decade in particular, wellness has become increasingly intertwined with appearance, self-optimisation and body management across generations. As healthcare professionals, we must ask whether our treatment models have kept pace with this reality.
When body modification becomes a family activity
For medical professionals, it’s critical to acknowledge that body modification is no longer an isolated pursuit. Intensive fitness cultures, calorie-tracking technologies and the growing use of GLP-1 medications for weight loss have become alarmingly normalised within family systems.
Parents and children are engaging in parallel conversations about food, exercise, weight management and appearance optimisation. In clinical work, we’re increasingly encountering families where multiple members are simultaneously pursuing weight-loss goals or a highly structured approach to food and exercise.
In some families, body size, food rules and self-surveillance come to dominate everyday interactions, and instead of bodies being valued for their function, they’re subtly (and in some cases deliberately) framed as projects requiring constant management and improvement.
For young people in a developmentally vulnerable phase of life, this environment can be difficult to navigate, regardless of how well-intentioned those around them may be.
The challenge of recovery in the home
Many young people leave eating disorder treatment having achieved weight restoration and significant symptom reduction. Clinically, this may be recorded as a “success”. Yet, they often return to family units where anxiety remains organised around food, where self-monitoring continues to occupy considerable emotional space.
It is in these circumstances that relapse may be less about treatment resistance and more about re-entry into an unchanged and reinforcing relational system.
We know that eating disorders do not exist in a vacuum, so the more clinically relevant focus here is whether the environments patients return to have been sufficiently addressed as part of the young person’s treatment. If the emotional climate, communication patterns, family anxieties and shared beliefs about food, bodies and self-worth remain largely untouched, recovery can become extraordinarily difficult to sustain.
It’s not uncommon for a young person to leave treatment with new coping strategies and improved symptom management, only to find themselves navigating the same relational dynamics that existed before clinical intervention began.
The hidden risks of wellness culture
Current services, especially publicly funded services operating under significant pressure, often lack the capacity and resources to address these wider dynamics. Once the immediate risk for the individual has reduced, the broader relational climate receives comparatively little sustained intervention.
Most families are not organised around pathology; they’re organised around wellness. Yet wellness itself can become a source of vulnerability when health behaviours become infused with anxiety and perfectionism. The pursuit of optimisation can gradually narrow a family’s emotional world until food, fitness and appearance occupy a disproportionate amount of psychological space.
This presents a particular challenge for concepts such as body neutrality. While body neutrality offers a valuable alternative to appearance-focused thinking, its implementation becomes increasingly difficult when body modification behaviours are highly visible, socially rewarded and often medically legitimised.
It’s certainly hard to teach a young person that bodies are not central to self-worth when the surrounding culture continually reinforces the opposite message.
Supporting families without blaming them
Most families are navigating extraordinarily complex cultural pressures with limited guidance and would benefit from support rather than scrutiny.
Supporting families effectively means moving beyond models that treat them as adjuncts to treatment rather than active participants in recovery; helping parents understand maintaining factors without diminishing their confidence or competence; and creating space for families to examine their own relationship with food, appearance, exercise and health without fear of judgement.
Sustainable recovery cannot rely solely on creating temporary safety within clinics, hospitals or treatment programmes. Young people recover within relationships, which means the goal must be to strengthen the environments they return to long after formal treatment has ended.
A turning point for eating disorder services
As wellness culture becomes increasingly embedded within family life, the distinction between individual pathology and collective behaviour is becoming harder to draw. Eating disorders are emerging within environments where food control, body surveillance and appearance management are often shared, normalised and reinforced across generations.
If treatment models continue to focus primarily on the identified patient, we risk overlooking the wider system that shapes recovery outcomes.
The next evolution of eating disorder care should not abandon individual treatment, but expand beyond it. Services must invest in more longitudinal, family-centred approaches that address communication, emotional safety, relational dynamics and family culture, alongside symptom reduction and weight restoration.
As body surveillance, food control and appearance optimisation become more commonplace in the fabric of family life, treatment models must evolve accordingly. The future of effective eating disorder care lies not only in treating the individual in front of us but in understanding and supporting the relational system that surrounds them.
