Eating disorders are among some of the most serious and challenging mental illnesses that affect children and young people. Eating disorders are characterised by the presence of unhealthy or extreme views of one’s weight and/or shape, which lead the young person to engage in dangerous eating and/ or exercise behaviours. These behaviours severely impact on the young person’s life, affecting their ability to function at school, home and in their relationships.
In 2012, it was estimated that around 4% of the Australian population suffered from an eating disorder, with females making up more than half the total (The Paying the Price Report). Estimates suggest up to 75% of adolescent girls perceive themselves as overweight or want to lose weight (www.nedc.com.au). Real prevalence rates may be even higher due to the secrecy, shame and guilt often associated with eating disorders in children and young people.
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While eating disorders in children and young people can start at any age, youth between the ages of 13-18 years appear to be most at risk (TPTPR). The Mission Australia’s Youth Survey, 2012, demonstrated that body image remains to be one of the top three issues concerning Australian young people. The age at which children are starting to think about body image and dieting appears to be reducing (American Academy of Pediatrics, 2003). Children as young as five years have identified the desire to be slimmer (Hamilton, conference) and around a quarter of our teenagers are experimenting with dangerous dieting behaviour (eg. taking laxatives, engaging in excessive exercise) (Hutchings,Conference). Australian research suggests that the prevalence of disordered eating behaviours have increased two-fold between 1995 and 2005 (TPTPR).
In light of this, knowing how to identify the signs of an eating disorder and knowing how to help your child are essential.
What are the types eating disorders?
There are several types of eating disorders in children and young people, with the most recognised being Anorexia Nervosa and Bulimia Nervosa.
- Anorexia Nervosa is characterised by significant weight loss, below what would be expected for the person’s age and height, with an accompanying intense fear of gaining weight or becoming ‘fat’. People with Anorexia Nervosa see their bodies in a distorted way, typically believing they are fat even when they are extremely underweight.
- Bulimia Nervosa is characterised by seemingly uncontrollable episodes of eating to excess, followed by behaviours aimed to rid the body of the calories ingested, such as undertaking excessive exercise, taking laxatives and vomiting. People with Bulimia have a preoccupation with their weight and shape and typically feel a great sense of guilt and shame, often meaning they go to great lengths to hide their behaviours.
While Anorexia Nervosa and Bulimia Nervosa are typically the most recognised eating disorders, the most common eating disorder is Eating Disorder Not Otherwise Specified (EDNOS), which affects more than half of those with a diagnosed eating disorder. A person experiencing EDNOS typically presents with a distorted view of their weight and shape, an intense fear of gaining weight and disturbed eating patterns. While a person with EDNOS will share but not meet all the criteria for Anorexia Nervosa and Bulimia Nervosa, the disorder is by no means any less significant or serious.
What causes eating disorders?
Two significant risk factors for developing an eating disorders to be aware of are:
- disordered eating eg. dieting, fasting, avoiding food groups. Australian and New Zealand research indicates that engaging in moderate dieting behaviour puts young people at a six-fold risk of developing an eating disorder and that engaging in extreme dieting puts young people at an 18-fold risk (www.nedc.com.au).
- body dissatisfaction eg. feelings of shame and anger over one’s body shape, preoccupation with body shape, distorted body image (TPTPR).
While there is no one cause of eating disorders, genetic vulnerabilities (eg. a parent with restrictive eating behaviours), psychological factors (eg. low self esteem, perfectionists traits), cultural factors (eg. a culture that promotes thinness and dieting) and stress (eg. bereavement) all appear to play a role in the development of eating disorders.
How can I tell if my child may be developing an eating disorder?
Below are some signs that your child could be developing an eating disorder. Of all the signs, disordered eating, such as restrictive dieting, fasting, limiting food groups, binge eating, laxative use, self induced vomiting and using diet pills, is the most significant indicator that your child may be developing an eating disorder.
Additional signs include:
- Physical changes: for example, significant changes in weight and weight loss, disturbed menstruation in females, general lethargy and looking pale and gaunt, feelings of dizziness, dehydration, sleep difficulties, dental decay.
- Behavioural changes: for example, frequent weighing of self and commenting on being ‘fat’, secretive eating habits, wearing baggy clothes to conceal weight loss, denying there is a problem, attempting to harm oneself, withdrawing from socialising and family life.
- Psychological Signs: for example, expressing fear of gaining weight, foods and bodily changes, self loathing, expressions of guilt, changes in mood and loss of motivation and enthusiasm for life.
What do I do if I am concerned that my child has an eating disorder?
Early intervention is best when it comes to treating eating disorders. People with eating disorders commonly attempt to hide their eating behaviours and weight changes from family and friends and so early detection can be difficult. Here are some tips for parents:
- be familiar with your child’s eating habits by regularly eating together. This will help you recognise if eating habits change and/ or become restrictive
- listen to how your child discusses food – are they talking about dieting, ‘bad’ foods, being fat?.
- look at your child – has their mood changed? are they more difficult or secretive at meal times? Are they struggling with getting to sleep and/ or worrying about their body image?
If so, these are warning signs that your child needs help. Given that eating disorders can result in serious medical complications it is advisable that the first step be a visit to your GP.
The good news is, with intervention, support and commitment to recovery, eating disorders are treatable. Treatment for an eating disorder typically involves the help of variety of people including a psychologist, nutritionist, GP, paediatrician, psychiatrist and specialist physician. This ‘team approach’ is aimed to address the eating disorder from a medical and psychological perspective and support all of the child’s needs. While some children may require hospitalisation if they are acutely unwell, treatment typically occurs in a community setting.
Treatments of eating disorders in children and young people typically take a family focus. Families are involved in all treatment phases, for example, in helping their child gain control of disordered eating behaviours and supporting their child in addressing some of the psychological and emotional issues that arise.Treatment involves helping the child/ young person back to a healthy weight range while addressing their distorted attitudes to themselves and food.
Families form an important part of treatment, as children and young people with eating disorders do not always view their eating as and problem and often minimise their problem behaviours. Showing your child that you are concerned about them and available to help is an essential role parents and caregivers have in the recovery process.
Recovery is an individual process that can be lengthy and include many ups and downs. The important thing to remember is that bumps in the road are common, however, should be viewed as learning tools rather than setbacks. Focus on what you and your child have learnt from the experience rather than the negatives and frequently reflect on the overall gains your child has made.
As a parent and/or caregiver, it is important to reflect healthy ideas about your own body image, avoid looking in the mirror and making negative comments about yourself, share with your child all the things you value about them that are not associated with their weight or shape and remind them of all the positives associated with getting better.
What can we do as a community?
Today’s society can be a challenging one for our children to grow up in. The constant portrayals in the media of super skinny women and muscled men can lead children to measure themselves against ideals which are hard or impossible to obtain.
As a community, some ways to help our young people cope with these influences are:
- Discuss with children that media portrayals are typically unrealistic and misrepresented. Media portrayals of models and celebrities are typically airbrushed, photoshopped and reconfigured in such a way, that moves these images dangerously away reality. Help your child critique the images they see and view them for what they really are.
- Limit and filter images that you child is seeing in the media and create a space for open discussion when unrealistic images are viewed.
- Discuss the uniqueness of individuals. Help children and young people identify unique qualities in themselves and their friends which make them valuable and important members of society. Help children recognise that they are more than what they look like and that being a certain body shape does not bring happiness, success or love.
- Be a role model: focus on your own positive qualities and talents, express positive attitudes to your own body, have a healthy and balanced lifestyle that incorporates healthy eating and exercise and focus on healthy-lifestyle goals rather than weight-loss focused goals
- Say positive things to yourself and others each day. Children and adolescents form beliefs about themselves from others around them. Being positive and content helps children internalise these attitudes for themselves.
- Lobby the media, fashion and advertising industries to adhere to codes such as The Voluntary Industry Code of Conduct on Body Image and Positive Body Image, which support the use of positive body image practices.
The Mission Australia’s Youth Survey 2012
National Eating Disorders Collaboration 2011
What’s Happening to our Girls? What’s Happening to our Boys? 2012 Booked Out Conference Sydney
American Academy of Pediatrics (2003). Policy statement: Identifying and treating eating disorders. Pediatrics, 111,
The Paying The Price Report: The economic and social impact of eating disorders in Australia
Headspace: National Youth Mental Health Foundation: Myth Buster: Eating Disorders Fact Sheet