Eating disorders are difficult to diagnose and have the highest death rate of all mental disorders.
According to Eating Disorder Hope, eating disorders do not discriminate. These disorders are complex mental afflictions that can affect anyone, regardless of age, sex or race.
While this is true, globally there is a high prevalence of eating disorders among young children and teenagers.
We approached clinical psychologist Janet Earl to help us answer common questions about the topic.
1. As a parent, what signs should I be looking out for in my child/teenager?
It is very important for parents to be aware of potential warning signs of an underlying eating disorder because the earlier one intervenes and gets treatment, the better the prognosis. Warning signs include (but are not limited to):
- Strict dieting, and eating becoming increasingly more restrictive
- Often refusing to eat certain foods or food groups
- Excessive amounts of food disappearing (potential bingeing)
- Habitual trips to the bathroom after meals/eating
- Social withdrawal (one of the earliest and key warning signs)
- Avoidance of eating meals with family or friends and of situations where food is present
- Increased preoccupation with food
- Exercising excessively and compulsively
- Mood changes, such as increased irritability
- Frequent and compulsive weighing, as well as increased preoccupation with weight and body shape
- Amenorrhoea (loss of menstruation) or menstrual irregularity
- Increased tiredness
2. I heard that eating disorders are not restricted to anorexia or losing weight. What is your comment on binge eating? How prevalent is it?
The three main types of eating disorders identified in the DSM 5 (diagnostic manual) are anorexia nervosa, bulimia nervosa and binge eating disorder. Of the three, binge eating disorder is the most common. It affects a broader range of people than anorexia and bulimia. It is quite common especially among those who are obese and in chronic dieters. The gender distribution is also more even with about a third of cases being male.
The age range is also broader, stretching from teens to middle age. While binge eating disorder is a full-blown eating disorder (i.e. it can be diagnosed), one also sees disordered eating or emotional eating. Binge eating is a common feature of emotional eating.
3. How do I establish a healthy food environment in my home without making my young daughter or son obsess about food?
The primary goal is to enable our children to establish a healthy relationship with food and with their bodies. It is important to eliminate food as a main focus point in their lives. It is there for fuel and to be enjoyed. Give your child healthy food choices to empower them in the food space. Try and offer healthy food choices but have treat food available for them. Help your children separate food and feelings. Help your child to tune inward and identify their own signals. Are they anxious or are they physically hungry?
A useful question is, “What are you hungry for?” It could be physical hunger, or an emotional need for affection. Help them to tune in and identify fullness and hunger. Do not be overly restrictive on treats as this can set up feelings of deprivation. This is key in the development of eating disorders. As parents, it is important to deal with your own issues with food and your body. If you model a healthy relationship with food, your child will be more likely to develop their own healthy relationship with food.
Create a home environment where there is an eating routine and where the body is nourished regularly. Establish regular mealtimes rather than constant snacking.
4. I want to build body confidence in my young teenager. How can I do that?
Poor self-esteem is evident in all eating disorders and often gets linked to a number on the scale. Your teenager may think, "If I achieve a certain weight, I will feel better about myself." This, however, is not true. To build body confidence it is important to build internal self-esteem. Help your teenager to see their body as a whole. (There may be parts they like and parts they don't.) Help them deal with emotional issues so that these don’t get “stored” in the body.
5. My teenager is overweight and I want to help, but I don’t want to do damage. What should I do as a parent?
Focus on building a healthy food environment at home. Do not become a policeman around food. Help your child to build a healthy relationship with food rather than focusing on losing weight. Help them separate food and feelings, and to become more mindful around food. Seek professional help.
6. Many of us still believe that only girls are susceptible to eating disorders. How often do you come across boys with the problem? How can we raise awareness about eating disorders?
While boys are less exposed to general sociocultural pressure to be slim, they are also at risk for eating disorders. Boys are more likely to develop binge eating disorder than anorexia or bulimia. Some, however, do present with anorexia and bulimia.
Boys can manifest what is known as “muscle dysmorphia” or body dysmorphic disorder. This is characterised by a subjective perception of thinness or preoccupation with a perceived small build, and wanting to be larger and more muscular. Boys with this condition focus excessively on diet, exercise and body fat (often using steroids). One can raise awareness through education and early intervention.
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