Parents are being encouraged to look out for signs of anorexia, bulimia and other conditions this Eating Disorder Awareness Week, following a dramatic rise in the number of hospital admissions for children with eating disorders.
There has been a rise in admissions in all parts of the country, according to NHS Digital data for England. Figures for April to October 2021 reveal there were 4,238 hospital admissions for children aged 17 and under, up 41% from 3,005 in the same period the year before.
The 2021 figure also shows a 69% rise on the pre-pandemic year of 2019.
“The hidden epidemic of eating disorders has surged during the pandemic," says Dr Agnes Ayton, chair of the eating disorders faculty at the Royal College of Psychiatrists. "Many community services are now over-stretched and unable to treat the sheer number of people needing help.
“We are at the point where we cannot afford to let this go on any longer."
Eating disorders are often characterised by eating too much or too little, being obsessed with weight or body shape, excessive exercise, having strict food routines and/or deliberate vomiting after eating.
The most common types of eating disorders include anorexia, bulimia, binge eating disorder and avoidant/restrictive food intake disorder (ARFID). Anorexia has the highest mortality rate of any mental illness, according to eating disorders charity BEAT.
Around 1.25 million people in the UK suffer from these illnesses, spanning all ages, genders and backgrounds.
Experts say early intervention is one of the key factors in aiding recovery and preventing serious illness and are calling on the government to ensure all healthcare professionals are trained in recognising the early signs of eating disorders.
Parents are also being advised to look out for potential early signs, but symptoms of eating disorders are not always easy to spot in your own children.
"Eating disorders are often very secretive illnesses," explains psychotherapist Kerrie Jones, founder and CEO of eating disorder treatment service, Orri.
"They can progressively develop over time meaning that it can be hard to spot there’s a problem until the physical symptoms are unavoidable and concerning."
Another issue is that every person’s experience of their illness will be unique to them, which means it can be hard to know what to look out for in the beginning.
Parents may also misinterpret early signs of an eating disorder – or even be in denial at first.
"It is so very painful for parents to notice signs of anorexia in their own children," explains Dr Jeanne Magagna, a child and adolescent psychotherapist and spokesperson for the Association of Child Psychotherapists (ACP), who is an expert in eating disorders.
"For this reason, even though they can see anorexic symptoms in others' children, they may feel so hurt and guilty when their child rejects food, somehow representing life and parents, that they miss obvious signs of eating disorders.
"This is particularly true when their child who was initially somewhat overweight starts restricting intake of food," she adds.
Nevertheless, there are some clues and symptoms parents can be aware of in order to spot if their child might be struggling.
Signs and symptoms of eating disorders
Isolation and secrecy
Eating disorders thrive in isolation, according to Jones, so you might notice someone spending less time socialising, distancing themselves from others or in general becoming less communicative.
"Isolation serves a purpose to keep the eating disorder from being unchallenged, so it’s vitally important to remain connected and in contact with children who you think are struggling," she advises.
"There can be a lot of shame and secrecy surrounding eating disorders, so it might take a while for a child or teen to admit that they have a problem."
Preoccupation with food
A very common sign of an eating disorder, according to Jones, is a preoccupation with food and eating. "You might notice your child becoming hyper-focused on food, talking more about the nutritional content of food, or labelling foods as strictly ‘good’ or ‘bad’.
"They might be counting calories, planning food in advance or appearing increasingly concerned about the preparation of food," she continues.
In older children this preoccupation may show up on social media, as the focus on food can materialise in taking pictures of food and tracking what they’ve eaten.
Disordered perception of their body
You might notice that your child is making increasingly frequent, negative comments about their body weight or shape.
"For some, the person they see in the mirror may be completely different to who you see in front of you," Jones explains. "You might catch them checking their reflection in the mirror or grasping or touching parts of their body – called 'body checking'."
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Fear of gaining weight
Often someone with an eating disorder develops a fear of putting on weight or obsessively pursues thinness, says Jones.
"They may do this by cutting out certain food groups under the guise of ‘health’. They may adopt veganism and vegetarianism in an attempt to remove fear foods in a socially acceptable manner," she explains.
"They may also compensate for anything they eat by over-exercising or taking frequent trips to the bathroom to purge any food eaten by vomiting or taking laxatives."
Whilst the food can be a distracting symptom, Jones says it is important to pay attention to your child's emotional state.
"Someone might become increasingly anxious or depressed," she says. "They may become angry or aggressive as a means of defending the eating disorder from challenge.
"Often, as someone’s eating disorder develops their sense of self-worth and mood can rapidly deteriorate. They may start to constantly question themselves, with a sense of 'never being good enough' creeping over them," Jones adds.
Whilst weight is by no means the only indicator of an eating disorder, Jones says a significant change in weight is important to take notice of.
"Someone might struggle with physical activity, become light-headed when getting off the sofa," she advises. "They may struggle with digestive issues and struggle to feel warm, no matter how warm the environment. They also may be pale and tired-looking."
Anxiety at mealtimes
Your child may also appear very nervous at mealtimes. "They may struggle to eat food or certain foods, particularly in front of others, and may prefer to eat by themselves or in their bedroom," Jones says. "They might ask to prepare the food themselves."
Jones advises parents also look out for children developing food "rituals". "Methodical and repeated behaviours around mealtimes or meal preparation that help them feel in control," she explains. "An example would be cutting their food into tiny pieces or taking a very long time to eat a meal."
You may also your child becoming progressively self-critical. "They may lack self-esteem and seem to have become more introverted or reticent," Jones says.
How parents can help if they think their child may be struggling
Check in with them
Eating disorders thrive in isolation, as Jones points out, so it’s vital that lines of communication are kept open so children feel they can talk if they need to.
"It’s important to pick a time to talk when tensions aren’t running high and when the individual appears open and receptive," she advises. "Be gentle as you address your concerns and focus on their emotional state more than the symptoms of the eating disorder."
Jones also suggests trying to stay calm if they begin to get defensive and just return to the fact that you are concerned for them and simply want to let them know you’re there for them.
"You may need to return to the conversation multiple times depending upon how ready they are to talk," she adds.
Educate and inform yourself
There are many myths and misconceptions about eating disorders, so it’s important parents educate and inform themselves about the illness so their loved one feels more understood.
"The person suffering may be very confused themselves about what’s happening, so having compassionate wisdom up your sleeve can help them to feel supported," Jones explains.
Dr Magagna suggests reading some books on the subject including A Short Introduction to Understanding and Supporting Children with Eating Disorders by Lucy Watson and Bryan Lask and her own book Psychotherapeutically Understanding Children and Young People with Eating Disorders.
Know that recovery is possible
While everyone’s recovery pattern is different, and there will be ups and downs along the way, Jones says holding onto hope during even the darkest of times is important. "It’s what keeps people going in their journey," she adds.
Remember your own self-care
As tempting as it may be to let your own self-care slide in order to prioritise caring for your loved one, you have to ensure you’re looking after yourself too.
"Know that you, too, are deserving of support as the experience of watching a loved one suffer with an eating disorder can take its toll," explains Jones.
"Our charity partner, the eating disorders charity, Beat, offers a variety of online services for people suffering as well as their friends/carers."
The following organisations also offer advice online:
Seek professional help
Eating disorders are complex mental illnesses and if left without intervention can become entrenched, making recovery more challenging. "Finding a specialist who can help is vitally important," Jones explains.
If you think your child may have an eating disorder, see a GP as soon as you can.
A GP will ask about their eating habits and how they're feeling, plus check their overall health and weight.
They may refer them to an eating disorder specialist or team of specialists.
You can also talk in confidence to an adviser from eating disorders charity Beat by calling their adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.