Abundant food is central to most Christmas celebrations, making it a stressful time for anyone with an eating disorder. There’s no hiding from the turkey, the ham, the mince pies or whatever you’re having yourself, amid long hours of socialising.
No sooner have we polished off the leftovers than we’re straight into talk of New Year diets and exercise regimes. This seasonal “see-sawing” of food consumption is not unusual, but it’s a time of year that can put a spotlight on truly disordered eating.
Here, consultant child and adolescent psychiatrist Dr Sara McDevitt, who chairs the eating disorder special interest group of the College of Psychiatrists of Ireland, advises parents on what to look out for and what to do if they are concerned about their child’s relationship with food.
Lots of children and teenagers seem to have some sort of issue with food, so what are the signs that there is something to worry about?
Yes, there’s a lot of mixed messaging about nutrition and exercise these days and this has led to people feeling very uncertain about what’s healthy, with some unbalanced eating and exercise habits developing. However, when we are thinking about eating disorders, this is about a much smaller group of people (about two to three teenagers in every 100) who have developed a moderate to severe clinical condition.
Everyone is different and there is a range of eating disorders. However, developing an eating disorder always involves a change in behaviours and attitudes to food, with a negative impact on physical and mental wellbeing.
Risk behaviours to look out for include cutting out major food groups (“clean eating”); starting to skip meals often; spending time in the bathroom just after eating (purging); using diet or other supplements; avoiding eating with other people or secretive eating. Physically, a change in weight may be noticed, but some people may hide this under loose clothing, and eating disorders occur at all weights and shapes.
Some teenagers over-exercise, but it is not healthy, social or fun exercise, it is just about burning calories. The child may become withdrawn or preoccupied with food, calories, shape and may seem low in mood or anxious. Physical signs that things are very serious include fainting, weakness or tummy problems.
What are the main types of eating disorders?
There are four main ones: anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding or eating disorder (Osfed). Avoidant restrictive food intake disorder (Arfid) is a feeding disorder and is also part of the spectrum of feeding and eating disorders.
Is there one root cause?
Eating disorders are complicated and there is no single root cause. They can affect anyone regardless of shape, weight, gender, ethnicity and age, so they are definitely not a lifestyle choice or anyone’s fault. We now know that 40-50 per cent of the tendency for someone to develop anorexia nervosa and bulimia nervosa disorder comes from genetic vulnerability. There are other factors that trigger the eating disorder such as puberty, hormones, social or environmental stressors like trauma, bullying, family and other stressors. Factors such as starvation, dieting habits, social media and certain personality traits have a role in both triggering an eating disorder and keeping it going.
In your experience, is social media an aggravating factor?
Many of the families we work with report that social media both triggers and maintains the eating disorder thoughts and behaviour. One recovered young person I spoke to told me that she wished that someone had just said “stop” to her at the very start about her phone use. It’s not just the social sharing and commenting on photos, body and following dieters. Apps that promote exercise and calorie counting or lists of healthy/unhealthy foods can trigger eating disorder thinking and behaviour in those who are vulnerable. Such behaviours are the opposite of the long-term intuitive, healthy balanced lifestyles that people really want.
We advise young people to think seriously about their online world. Is it making them feel worse or better after they log on? If not, we recommend they detox from it for a while, at least during treatment and recovery. This can mean deleting certain apps, avoiding social media in the evenings or night-time, putting the step counter away and making a personal digital detox plan.
What approach should I take as I am afraid drawing attention to their eating could make matters worse?
It’s important to talk with your child if you are concerned. Early intervention really helps and that starts at home with communication. So, finding a one-to-one time to talk with them, away from the stress of the dinner table, is important. Aim for a supportive chat rather than confronting them. Express your concern for their wellbeing, and first ask them about what has changed and why they are feeling like this, rather than telling them what to do. Lots of empathy is needed here as your child may be very unhappy inside. It is also important to be firm if you need to arrange a GP visit, even if your child is reluctant. Health first is an important message.
Where should I go for professional help?
Your GP is the first point of call if you are concerned, as they will be able to assess and examine your child and make a referral. The national eating disorder support organisation Bodywhys has a helpline (01-2107906) and website (bodywhys.ie) with lots of information you can look at together, and they have a fantastic range of support groups for people with eating disorders and parents. We recommend their PILAR and Maudsley Parents groups to all parents of young people referred to our service. The HSE National Clinical Programme for Eating Disorders (NCPED) also has a free self-help and information app with lots of great information on eating disorders, services, treatments and day-to-day advice, for example how to manage in school, as well as recovery blogs.
Is there anything I can ask extended family or my child’s peers to do in support?
I think that the main thing is to keep including them in the social circle even if they seem quiet or unwell. Eating disorders can be frighteningly isolating, so just staying in touch and keeping connected can make a big difference. The person you love happens to have an eating disorder right now, but it’s still them. It can be helpful to arrange social events and meetings around non-food/exercise-related events or places, for example going to a film instead of a restaurant.
Even if they seem to recover, will the eating disorder be always lurking and likely to reoccur?
The vulnerability to an eating disorder remains but of course people can and do recover fully from eating disorders. The range of outcomes is wide. Most young people go on to leave the eating disorder behind them for good. For others the eating disorder may linger for a few years or be with them for a longer time.
The research tells us that early access to treatment (within the first three years) and early weight restoration if underweight give the best chance of a full recovery. But of course, many people also recover when the eating disorder has been there for a long time.
Are there any parental ‘dos’ and ‘don’ts’ that might help prevent a child developing an eating disorder?
People don’t cause eating disorders – neither parents nor their children. However, parents are great social models for their children to learn from in managing some of the triggers.
Some tips would be:
- Develop an atmosphere at home which promotes balanced eating, sleep and exercise rather than the diet or “good food/ bad food” culture. Best health at every size and shape is an important message for teenagers and children and you can model it too.
- Encouraging regular eating and family mealtimes are really healthy habits. Life is busy but these are family cornerstones that promote food and nutrition as restorative and social – and that’s an important message.
- Encourage your child to think critically and become tech smart about media and social media messaging around health, social influencing and the pros and cons of tech.
- Keep communication open at home about emotional wellbeing and how to manage stress. This will give them a person to turn to and a place to figure things out if some of the triggers such as bullying, social and educational stresses become overwhelming.
- Talk to your GP early on if you are concerned. Just a chat and some practical, specific advice may get things on track before an eating disorder develops.
What could I do to make Christmas easier for a child with an eating disorder?
Christmas can be overwhelming because of the change in routine, food focus and social visiting.
Top tips for parents are to plan with your child in advance around social visits, meals and snacks, and to include social activities and conversation at mealtimes that aren’t all food focused. Many people find it helpful to stick to their usual mealtime routine as much as possible to reduce anxiety. The NCPED self-care app has some great tips to support you in this.
Other helpful websites: freedfromed.co.uk/resources-for-patients-carers; feast-ed.org; beateatingdisorders.org.uk
